scholarly journals Procurement Biopsies in the Evaluation of Deceased Donor Kidneys

2018 ◽  
Vol 13 (12) ◽  
pp. 1876-1885 ◽  
Author(s):  
Dustin Carpenter ◽  
S. Ali Husain ◽  
Corey Brennan ◽  
Ibrahim Batal ◽  
Isaac E. Hall ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Vascular Disease ◽  
Graft Failure ◽  
Interstitial Fibrosis ◽  
Frozen Section ◽  
Deceased Donor ◽  
Hazard Ratio ◽  
Donor Kidney ◽  
Tubular Atrophy ◽  
Deceased Donor Kidney

Background and objectivesBiopsies taken at deceased donor kidney procurement continue to be cited as a leading reason for discard; however, the reproducibility and prognostic capability of these biopsies are controversial.Design, setting, participants, & measurementsWe compiled a retrospective, single-institution, continuous cohort of deceased donor kidney transplants performed from 2006 to 2009. Procurement biopsy information—percentage of glomerulosclerosis, interstitial fibrosis/tubular atrophy, and vascular disease—was obtained from the national transplant database. Using univariable, multivariable, and time-to-event analyses for death-censored graft survival, we compared procurement frozen section biopsy reports with reperfusion paraffin-embedded biopsies read by trained kidney pathologists (n=270). We also examined agreement for sequential procurement biopsies performed on the same kidney (n=116 kidneys).ResultsFor kidneys on which more than one procurement biopsy was performed (n=116), category agreement was found in only 64% of cases (κ=0.14). For all kidneys (n=270), correlation between procurement and reperfusion biopsies was poor: overall, biopsies were classified into the same category (optimal versus suboptimal) in only 64% of cases (κ=0.25). This discrepancy was most pronounced when categorizing percentage of glomerulosclerosis, which had 63% agreement (κ=0.15). Interstitial fibrosis/tubular atrophy and vascular disease had agreement rates of 82% (κ=0.13) and 80% (κ=0.15), respectively. Ninety-eight (36%) recipients died, and 56 (21%) allografts failed by the end of follow-up. Reperfusion biopsies were more prognostic than procurement biopsies (hazard ratio for graft failure, 2.02; 95% confidence interval, 1.09 to 3.74 versus hazard ratio for graft failure, 1.30; 95% confidence interval, 0.61 to 2.76), with procurement biopsies not significantly associated with graft failure.ConclusionsWe found that procurement biopsies are poorly reproducible, do not correlate well with paraffin-embedded reperfusion biopsies, and are not significantly associated with transplant outcomes.

scholarly journals Reproducibility of Deceased Donor Kidney Procurement Biopsies

2020 ◽  
Vol 15 (2) ◽  
pp. 257-264 ◽  
Author(s):  
S. Ali Husain ◽  
Kristen L. King ◽  
Ibrahim Batal ◽  
Geoffrey K. Dube ◽  
Isaac E. Hall ◽  
...  
Keyword(s):  
Interstitial Fibrosis ◽  
Organ Procurement ◽  
Deceased Donor ◽  
Event Analysis ◽  
Time To Event ◽  
Allograft Survival ◽  
Donor Kidney ◽  
Tubular Atrophy ◽  
Deceased Donor Kidney ◽  
Probability Of Death

Background and objectivesUnfavorable histology on procurement biopsies is the most common reason for deceased donor kidney discard. We sought to assess the reproducibility of procurement biopsy findings.Design, setting, participants, & measurementsWe compiled a continuous cohort of deceased donor kidneys transplanted at our institution from 1/1/2006 to 12/31/2016 that had at least one procurement biopsy performed, and excluded cases with missing biopsy reports and those used in multiorgan transplants. Suboptimal histology was defined as the presence of advanced sclerosis in greater than or equal to one biopsy compartment (glomeruli, tubules/interstitium, vessels). We calculated κ coefficients to assess agreement in optimal versus suboptimal classification between sequential biopsy reports for kidneys that underwent multiple procurement biopsies and used time-to-event analysis to evaluate the association between first versus second biopsies and patient and allograft survival.ResultsOf the 1011 kidneys included in our cohort, 606 (60%) had multiple procurement biopsies; 98% had first biopsy performed at another organ procurement organization and their second biopsy performed locally. Categorical agreement was highest for vascular disease (κ=0.17) followed by interstitial fibrosis and tubular atrophy (κ=0.12) and glomerulosclerosis (κ=0.12). Overall histologic agreement (optimal versus suboptimal) was κ=0.15. First biopsy histology had no association with allograft survival in unadjusted or adjusted analyses. However, second biopsy optimal histology was associated with a higher probability of death-censored allograft survival, even after adjusting for donor and recipient factors (adjusted hazard ratio, 0.50; 95% confidence interval, 0.34 to 0.75; P=0.001).ConclusionsDeceased donor kidneys that underwent multiple procurement biopsies often displayed substantial differences in histologic categorization in sequential biopsies, and there was no association between first biopsy findings and post-transplant outcomes.

scholarly journals Sex Disparity in Deceased-Donor Kidney Transplant Access by Cause of Kidney Disease

2021 ◽  
Vol 16 (2) ◽  
pp. 241-250
Author(s):  
Patrick Ahearn ◽  
Kirsten L. Johansen ◽  
Jane C. Tan ◽  
Charles E. McCulloch ◽  
Barbara A. Grimes ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Kidney Transplant ◽  
Kidney Failure ◽  
Deceased Donor ◽  
The United States ◽  
Hazard Ratio ◽  
Donor Kidney ◽  
Deceased Donor Kidney

Background and objectivesWomen with kidney failure have lower access to kidney transplantation compared with men, but the magnitude of this disparity may not be uniform across all kidney diseases. We hypothesized that the attributed cause of kidney failure may modify the magnitude of the disparities in transplant access by sex.Design, setting, participants, & measurementsWe performed a retrospective cohort study of adults who developed kidney failure between 2005 and 2017 according to the United States Renal Data System. We used adjusted Cox models to examine the association between sex and either access to waitlist registration or deceased-donor kidney transplantation, and tested for interaction between sex and the attributed cause of kidney failure using adjusted models.ResultsAmong a total of 1,478,037 patients, 271,111 were registered on the waitlist and 89,574 underwent deceased-donor transplantation. The rate of waitlisting was 6.5 per 100 person-years in women and 8.3 per 100 person-years for men. In adjusted analysis, women had lower access to the waitlist (hazard ratio, 0.89; 95% confidence interval, 0.89 to 0.90) and to deceased-donor transplantation after waitlisting (hazard ratio, 0.96; 95% confidence interval, 0.94 to 0.98). However, there was an interaction between sex and attributed cause of kidney disease in adjusted models (P<0.001). Women with kidney failure due to type 2 diabetes had 27% lower access to the kidney transplant waitlist (hazard ratio, 0.73; 95% confidence interval, 0.72 to 0.74) and 11% lower access to deceased-donor transplantation after waitlisting compared with men (hazard ratio, 0.89; 95% confidence interval, 0.86 to 0.92). In contrast, sex disparities in access to either the waitlist or transplantation were not observed in kidney failure secondary to cystic disease.ConclusionsThe disparity in transplant access by sex is not consistent across all causes of kidney failure. Lower deceased-donor transplantation rates in women compared with men are especially notable among patients with kidney failure attributed to diabetes.

scholarly journals The Maryland Aggregate Pathology Index: A Deceased Donor Kidney Biopsy Scoring System for Predicting Graft Failure

2008 ◽  
Vol 8 (11) ◽  
pp. 2316-2324 ◽  
Author(s):  
R. B. Munivenkatappa ◽  
E. J. Schweitzer ◽  
J. C. Papadimitriou ◽  
C. B. Drachenberg ◽  
K. A. Thom ◽  
...  
Keyword(s):  
Scoring System ◽  
Graft Failure ◽  
Kidney Biopsy ◽  
Deceased Donor ◽  
Donor Kidney ◽  
Deceased Donor Kidney

Deceased-Donor Acute Kidney Injury and BK Polyomavirus in Kidney Transplant Recipients

2021 ◽  
pp. CJN.18101120
Author(s):  
Isaac E. Hall ◽  
Peter Philip Reese ◽  
Sherry G. Mansour ◽  
Sumit Mohan ◽  
Yaqi Jia ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Lower Risk ◽  
Graft Failure ◽  
Organ Procurement ◽  
Ischemia Reperfusion ◽  
Deceased Donor ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Multicenter Cohort ◽  
Bk Polyomavirus

Background and objectivesBK polyomavirus (BKV) infection commonly complicates kidney transplantation, contributing to morbidity and allograft failure. The virus is often donor-derived and influenced by ischemia-reperfusion processes and disruption of structural allograft integrity. We hypothesized that deceased-donor AKI associates with BKV infection in recipients.Design, setting, participants, & measurementsWe studied 1025 kidney recipients from 801 deceased donors transplanted between 2010 and 2013, at 13 academic centers. We fitted Cox proportional-hazards models for BKV DNAemia (detectable in recipient blood by clinical PCR testing) within 1 year post-transplantation, adjusting for donor AKI and other donor- and recipient-related factors. We validated findings from this prospective cohort with analyses for graft failure attributed to BKV within the Organ Procurement and Transplantation Network (OPTN) database.ResultsThe multicenter cohort mean kidney donor profile index was 49±27%, and 26% of donors had AKI. Mean recipient age was 54±13 years, and 25% developed BKV DNAemia. Donor AKI was associated with lower risk for BKV DNAemia (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79). In the OPTN database, 22,537 (25%) patients received donor AKI kidneys, and 272 (0.3%) developed graft failure from BKV. The adjusted hazard ratio for the outcome with donor AKI was 0.7 (95% confidence interval, 0.52 to 0.95).ConclusionsIn a well-characterized, multicenter cohort, contrary to our hypothesis, deceased-donor AKI independently associated with lower risk for BKV DNAemia. Within the OPTN database, donor AKI was also associated with lower risk for graft failure attributed to BKV.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_03_10_CJN18101120_final.mp3

scholarly journals Number of Donor Renal Arteries and Early Outcomes After Deceased Donor Kidney Transplantation

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005152021
Author(s):  
S. Ali Husain ◽  
Kristen L. King ◽  
Shelief Robbins-Juarez ◽  
Joel T. Adler ◽  
Kasi R. McCune ◽  
...  
Keyword(s):  
Graft Failure ◽  
Graft Function ◽  
Deceased Donor ◽  
Renal Arteries ◽  
Delayed Graft Function ◽  
Cold Ischemia ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Donor Kidney Transplantation ◽  
Deceased Donor Kidney Transplantation

Background: Anatomical abnormalities increase the risk of deceased donor kidney discard but their impact on transplant outcomes is understudied. We sought to determine the impact of multiple donor renal arteries on early outcomes after deceased donor kidney transplantation. Methods: For this retrospective cohort study, we identified 1443 kidneys from 832 deceased donors with ≥1 kidney transplanted at our center (2006-2016). We compared the odds of delayed graft function and 90-day graft failure using logistic regression. To reduce potential selection bias, we then repeated the analysis using a paired-kidney cohort including kidney pairs from 162 donors with 1 single-artery kidney and 1 multi-artery kidney. Results: Of 1443 kidneys included, 319 (22%) had multiple arteries. Multi-artery kidneys experienced longer cold ischemia time, but other characteristics were similar between groups. Delayed graft function (50% multi-artery vs 45% one artery, p=0.07) and 90-day graft failure (3% vs 3%, p=0.83) were similar between groups before and after adjusting for donor and recipient characteristics. In the paired kidney analysis, cold ischemia time was significantly longer for multi-artery kidneys compared to single-artery kidneys from the same donor (33.5 versus 26.1 hours, p<0.001), but delayed graft function and 90-day graft failure were again similar between groups. Conclusions: Compared to single-artery deceased donor kidneys, those with multiple renal arteries are harder to place but experience similar delayed graft function and early graft failure.

scholarly journals Declined offers for deceased donor kidneys are not an independent reflection of organ quality

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0004052021
Author(s):  
Kristen L King ◽  
Sulemon G Chaudhry ◽  
Lloyd E Ratner ◽  
David J Cohen ◽  
S Ali Husain ◽  
...  
Keyword(s):  
Graft Failure ◽  
Patient Survival ◽  
Risk Index ◽  
Deceased Donor ◽  
The United States ◽  
Survival Outcomes ◽  
Organ Shortage ◽  
Donor Kidney ◽  
Deceased Donor Kidney

Background: Deceased donor kidney offers are frequently declined multiple times before acceptance for transplantation, despite significant organ shortage and long waiting times. Whether the number of times a kidney has been declined, reflecting cumulative judgments of clinicians, is associated with long-term transplant outcomes remains unclear. Methods: In this national, retrospective cohort study of deceased donor kidney transplants in the United States from 2008 to 2015 (n=78,940), we compared donor and recipient characteristics and short- and long-term graft and patient survival outcomes grouping by the sequence number at which the kidney was accepted for transplantation. We compared outcomes for kidneys accepted within the first 7 offers in the match run, after 8-100 offers, and for hard-to-place kidneys distinguishing those requiring >100 and >1000 offers before acceptance. Results: Harder to place kidneys had lower donor quality and higher rates of delayed graft function (46% among kidneys requiring >1000 offers before acceptance versus 23% among kidneys with ≤7 offers). In unadjusted models, later sequence groups had higher hazard of all-cause graft failure, death-censored graft failure, and patient mortality; however, these associations were attenuated after adjusting for kidney donor risk index (KDRI). After adjusting for donor factors already taken into consideration during allocation and recipient factors associated with long-term outcomes, graft and patient survival outcomes were not significantly different for the hardest-to-place kidneys compared to the easiest-to-place kidneys, with the exception of death-censored graft failure (adjusted hazard ratio: 1.16, 95% CI: 1.05-1.28). Conclusions: Late sequence offers may represent missed opportunities for earlier successful transplant for the higher-priority waitlisted candidates for whom the offers were declined.

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