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Erschienen in:

19.10.2023 | original Article

Histological and clinical evaluation of discarded kidneys in a European cohort of deceased brain death donor kidneys of marginal quality

verfasst von: Florian G. Scurt, Carl-Ludwig Fischer-Fröhlich, Tamara Wassermann, Angela Ernst, Anke Schwarz, Jan U. Becker, Christos Chatzikyrkou

Erschienen in: Journal of Nephrology | Ausgabe 9/2023

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Abstract

Background

Despite organ shortages, the discard rate of deceased donor kidneys is high. Risk factors for this trend warrant further study.

Methods

We investigated reasons for discard in a cohort of brain death donors with marginal kidneys and procurement biopsies. Paraffin embedded procurement biopsies were systematically reevaluated and graded for the purpose of the study. Assessment included percentage of global glomerulosclerosis, Banff Lesion scores and tubular epithelial damage. Donor-, transplant process-, perfusion quality-, histopathology-, and recipient-related parameters were compared between discarded and transplanted organs.

Results

Although most clinical characteristics were similar between donors whose kidneys were transplanted and those whose kidneys were procured but discarded, discarded kidneys were more likely to be from donors with hepatitis C, to have undergone wedge biopsies, to show changes of acute and chronic injury and to be deemed poor quality. Except for obvious anatomic abnormalities, kidneys were often discarded due to the findings of procurement biopsies. Donors of kidneys discarded for histologic reasons more often had hypertension, coronary artery disease, stroke, and increased serum creatinine. The reason for discard was unknown in 20% of cases. Discarded kidneys came from donors who appeared to be clinically similar to donors whose kidneys were utilized for transplant.

Conclusion

A considerable proportion of discarded kidneys were of acceptable quality. The analysis of the outcome of every recovered organ could help to overcome this problem. Procurement biopsies more often lead to discard than to transplantation of recovered organs. Proper handling during allocation has to be determined.

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Frei U, Noeldeke J, Machold-Fabrizii V et al (2008) Prospective age-matching in elderly kidney transplant recipients—a 5-year analysis of the Eurotransplant Senior Program. Am J Transplant 8:50–57CrossRefPubMed

Merion RM, Ashby VB, Wolfe RA et al (2005) Deceased-donor characteristics and the survival benefit of kidney transplantation. JAMA 294:2726–2733CrossRefPubMed

Wolfe RA, Ashby VB, Milford EL et al (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341:1725–1730CrossRefPubMed

Lentine KL, Smith JM, Hart A et al (2022) OPTN/SRTR 2020 annual data report: kidney. Am J Transplant 22(Suppl 2):21–136CrossRefPubMed

Chatzikyrkou C, Scurt FG, Clajus C et al (2019) Predictors of outcomes of living kidney donation: impact of sex, age and preexistent hypertension. Transplant Proc 51:396–404CrossRefPubMed

Eckman MH, Woodle ES, Thakar CV et al (2020) Cost-effectiveness of using kidneys from HCV-viremic donors for transplantation into HCV-uninfected recipients. Am J Kidney Dis 75:857–867CrossRefPubMed

Furian L, Nicolò A, Di Bella C et al (2020) Kidney exchange strategies: new aspects and applications with a focus on deceased donor-initiated chains. Transpl Int 33:1177–1184CrossRefPubMed

Scurt FG, Ewert L, Mertens PR et al (2019) Clinical outcomes after ABO-incompatible renal transplantation: a systematic review and meta-analysis. Lancet 393:2059–2072CrossRefPubMed

Orandi BJ, Luo X, Massie AB et al (2016) Survival benefit with kidney transplants from HLA-incompatible live donors. N Engl J Med 374:940–950CrossRefPubMedPubMedCentral

10.

Scurt FG, Mertens PR, Chatzikyrkou C (2019) Clinical outcomes after ABO-incompatible renal transplantation—authors’ reply. Lancet 394:1989–1990CrossRefPubMed

11.

Stewart DE, Garcia VC, Rosendale JD et al (2017) Diagnosing the decades-long rise in the deceased donor kidney discard rate in the United States. Transplantation 101:575–587CrossRefPubMed

12.

Yu K, King K, Husain SA et al (2020) Kidney nonprocurement in solid organ donors in the United States. Am J Transplant 20:3413–3425CrossRefPubMedPubMedCentral

13.

Mohan S, Chiles MC, Patzer RE et al (2018) Factors leading to the discard of deceased donor kidneys in the United States. Kidney Int 94:187–198CrossRefPubMedPubMedCentral

14.

Zaza G, Cucchiari D, Becker JU et al (2023) European Society for Organ Transplantation (ESOT)-TLJ 3.0 consensus on histopathological analysis of pre-implantation donor kidney biopsy: redefining the role in the process of graft assessment. Transpl Int 36:11410CrossRefPubMedPubMedCentral

15.

Girolami I, Gambaro G, Ghimenton C et al (2020) Pre-implantation kidney biopsy: value of the expertise in determining histological score and comparison with the whole organ on a series of discarded kidneys. J Nephrol 33:167–176CrossRefPubMed

16.

Dasari S, Chakraborty A, Truong L et al (2019) A systematic review of interpathologist agreement in histologic classification of lupus nephritis. Kidney Int Rep 4:1420–1425CrossRefPubMedPubMedCentral

17.

Rao PS, Ojo A (2009) The alphabet soup of kidney transplantation: SCD, DCD, ECD–fundamentals for the practicing nephrologist. Clin J Am Soc Nephrol 4:1827–1831CrossRefPubMed

18.

Bellomo R, Ronco C, Kellum JA et al (2004) Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212CrossRefPubMedPubMedCentral

19.

Hamed MO, Chen Y, Pasea L et al (2015) Early graft loss after kidney transplantation: risk factors and consequences. Am J Transplant 15:1632–1643CrossRefPubMed

20.

Siedlecki A, Irish W, Brennan DC (2011) Delayed graft function in the kidney transplant. Am J Transplant 11:2279–2296CrossRefPubMedPubMedCentral

21.

Sapir-Pichhadze R, Pintilie M, Tinckam KJ et al (2016) Survival analysis in the presence of competing risks: the example of waitlisted kidney transplant candidates. Am J Transplant 16:1958–1966CrossRefPubMed

22.

Mengel M, Sis B, Haas M et al (2012) Banff 2011 Meeting report: new concepts in antibody-mediated rejection. Am J Transplant 12:563–570CrossRefPubMedPubMedCentral

23.

Liapis H, Gaut JP, Klein C et al (2017) Banff histopathological consensus criteria for preimplantation kidney biopsies. Am J Transplant 17:140–150CrossRefPubMed

24.

Gwinner W, Suppa S, Mengel M et al (2005) Early calcification of renal allografts detected by protocol biopsies: causes and clinical implications. Am J Transplant 5:1934–1941CrossRefPubMed

25.

Schumann-Bischoff A, Schmitz J, Scheffner I et al (2018) Distinct morphological features of acute tubular injury in renal allografts correlate with clinical outcome. Am J Physiol Renal Physiol 315:F701-f710CrossRefPubMed

26.

Pieters TT, Falke LL, Nguyen TQ et al (2019) Histological characteristics of acute tubular injury during delayed graft function predict renal function after renal transplantation. Physiol Rep 7:e14000CrossRefPubMedPubMedCentral

27.

Bajwa M, Cho YW, Pham PT et al (2007) Donor biopsy and kidney transplant outcomes: an analysis using the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) database. Transplantation 84:1399–1405CrossRefPubMed

28.

Sung RS, Christensen LL, Leichtman AB et al (2008) Determinants of discard of expanded criteria donor kidneys: impact of biopsy and machine perfusion. Am J Transplant 8:783–792CrossRefPubMed

29.

Cheungpasitporn W, Thongprayoon C, Vaitla PK et al (2020) Degree of glomerulosclerosis in procurement kidney biopsies from marginal donor kidneys and their implications in predicting graft outcomes. J Clin Med 9:1469CrossRefPubMedPubMedCentral

30.

Sood P, Randhawa PS, Mehta R et al (2015) Donor kidney microthrombi and outcomes of kidney transplant: a single-center experience. Clin Transplant 29:434–438CrossRefPubMed

31.

Li P, Gupta S, Mothi SS et al (2021) Histopathologic correlates of kidney function: insights from nephrectomy specimens. Am J Kidney Dis 77:336–345CrossRefPubMed

32.

Becker JU, Mayerich D, Padmanabhan M et al (2020) Artificial intelligence and machine learning in nephropathology. Kidney Int 98:65–75CrossRefPubMedPubMedCentral

Titel: Histological and clinical evaluation of discarded kidneys in a European cohort of deceased brain death donor kidneys of marginal quality
verfasst von: Florian G. Scurt
Carl-Ludwig Fischer-Fröhlich
Tamara Wassermann
Angela Ernst
Anke Schwarz
Jan U. Becker
Christos Chatzikyrkou
Publikationsdatum: 19.10.2023
Verlag: Springer International Publishing
Erschienen in: Journal of Nephrology / Ausgabe 9/2023
Print ISSN: 1121-8428
Elektronische ISSN: 1724-6059
DOI: https://doi.org/10.1007/s40620-023-01785-8

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Abstract

Background

Methods

Results

Conclusion

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