Histopathological evaluation of pretransplant donor biopsies in expanded criteria donors with high kidney donor profile index: a retrospective observational cohort study
Corresponding Author
Ana Sánchez-Escuredo
Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Correspondence
Ana Sánchez-Escuredo, Nephrology and Renal Transplant Department, Hospital Clinic, Villarroel, 170, 08036 Barcelona, Spain.
Tel.: (34) 932275423;
fax: (34) 932275498;
e-mail: [email protected]
Search for more papers by this authorAmaia Sagasta
Pathology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorIgnacio Revuelta
Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorLida M. Rodas
Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorDavid Paredes
Transplant Service Foundation, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorMireia Musquera
Urology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorFritz Diekmann
Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorJosep M. Campistol
Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorManel Solé
Pathology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorFederico Oppenheimer
Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorCorresponding Author
Ana Sánchez-Escuredo
Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Correspondence
Ana Sánchez-Escuredo, Nephrology and Renal Transplant Department, Hospital Clinic, Villarroel, 170, 08036 Barcelona, Spain.
Tel.: (34) 932275423;
fax: (34) 932275498;
e-mail: [email protected]
Search for more papers by this authorAmaia Sagasta
Pathology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorIgnacio Revuelta
Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorLida M. Rodas
Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorDavid Paredes
Transplant Service Foundation, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorMireia Musquera
Urology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorFritz Diekmann
Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorJosep M. Campistol
Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorManel Solé
Pathology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorFederico Oppenheimer
Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorSummary
There is no consensus on the allocation of renal transplants from expanded criteria donors (ECD). The Kidney Donor Profile Index (KDPI) is used without the need for pretransplant donor biopsies (PTDB). We explored whether PTDB based on Remuzzi Score (RS) allows identification of those marginal kidneys in the highest calculated KDPI risk group (>91%) that appropriate for single transplantation. A retrospective study was conducted of 485 consecutive kidneys procured from a single center and transplanted if the RS was ≤4. We compared 5-year kidney and patients survival between KDPI groups and between RS <4 or =4 in the highest KDPI group. The median KDPI (interquartile range) was 71 (66–76) for KDPI <80% (n = 77), 86 (81–90) for KDPI 81–90% (n = 82), and 97 (94–100) for KDPI >91% (n = 205). Patient survival at 5 years was 85.7%, 85.3%, and 76.09% (P = 0.058) and death-censored graft survival was 84.4%, 86.5%, 73.6% (P = 0.015), respectively for each KDPI group. In >91% calculated KDPI group, there were no differences in graft survival depending on the RS (<4 vs. =4) (P = 0.714). The implementation of PTDB based on RS used for allocation of organs with the highest KDPI range could support to the acceptance of suitable organs for single transplantation with good patient and graft survival rate.
References
- 1Port FK, Bragg-Gresham JL, Metzger RA, et al. Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors. Transplantation 2002; 74: 1281.
- 2Ojo AO, Hanson JA, Meier-Kriesche H, et al. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol 2001; 12: 589.
- 3Pascual J, Zamora J, Pirsch JD. A systematic review of kidney transplantation from expanded criteria donors. Am J Kidney Dis 2008; 52: 553.
- 4Remuzzi G, Cravedi P, Perna A, et al. Long-term outcome of renal transplantation from older donors. N Engl J Med 2006; 354: 343.
- 5Azancot MA, Moreso F, Salcedo M, et al. The reproducibility and predictive value on outcome of renal biopsies from expanded criteria donors. Kidney Int 2014; 85: 1161.
- 6Nicholson ML, Hosgood SA. Renal transplantation after ex vivo normothermic perfusion: the first clinical study. Am J Transplant 2013; 13: 1246.
- 7El-Husseini A, Sabry A, Zahran A, Shoker A. Can donor implantation renal biopsy predict long-term renal allograft outcome? Am J Nephrol 2007; 27: 144.
- 8Shapiro R, Halloran PF, Delmonico FL, Bromberg JS. The ‘two, one, zero’ decision: what to do with suboptimal deceased donor kidneys. Am J Transplant 2010; 10: 1959.
- 9 European Renal Best Practice Transplantation Guideline Development Groups. ERBP guideline on the management and evaluation of the kidney donor and recipient. Nephrol Dial Transplant 2013; 28(Suppl. 2): ii1.
- 10Furness PN, Taub N. International variation in the interpretation of renal transplant biopsies: report of the CERTPAP Project. Kidney Int 2001; 60: 1998.
- 11De Vusser K, Lerut E, Kuypers D, et al. The predictive value of kidney allograft baseline biopsies for long-term graft survival. J Am Soc Nephrol 2013; 24: 1913.
- 12Wang CJ, Wetmore JB, Crary GS, Kasiske BL. The donor kidney biopsy and its implications in predicting graft outcomes: a systematic review. Am J Transplant 2015; 15: 1903.
- 13Sung RS, Christensen LL, Leichtman AB, et al. Determinants of discard of expanded criteria donor kidneys: impact of biopsy and machine perfusion. Am J Trasplant 2008; 8: 783.
- 14Rao PS, Schaubel DE, Guidinger MK, et al. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation 2009; 88: 231.
- 15 Organ Procurement and Transplantation Network (OPTN): Kidney Donor Profile Index Calculator. https://optn.transplant.hrsa.gov/resources/allocation-calculators/kdpi-calculator/ Accessed June 2015.
- 16Gandolfini I, Buzio c, Zanelli A, et al. The kidney donor profile index (KDPI) of marginal donor allocated by standardized pretransplant donor biopsy assessment: distribution and association with graft outcomes. Am J Transplant 2014; 14: 2515.
- 17Tanriover B, Mohan S, Cohen DJ, et al. Kidneys at higher risk of discard: expanding the role of dual kidney transplantation. Am J Transplant 2014; 14: 404.
- 18Fritsche L, Horstrup J, Budde K, et al. Old-for-old kidney allocation allows successful expansion of the donor and recipient pool. Am J Transplant 2003; 3: 1434.
- 19Sagasta A, Sánchez-Escuredo A, Oppenheimer F, et al. Pre-implantation analysis of kidney biopsies from expanded criteria donors: testing the accuracy of frozen section technique and the adequacy of their assessment by on-call pathologists. Transpl Int 2016; 29: 234.
- 20Tso PL. Access to renal transplantation for the elderly in the face of new allocation policy: a review of contemporary perspectives on “older” issues. Transplant Rev 2014; 28: 6.
- 21Snyder JJ, Salkowski N, Wey A, et al. Effects of high-risk kidneys on scientific registry of transplant recipients program quality reports. Am J Transplant 2016; 16: 2646.
- 22http://www.ont.es/infesp/Memorias/Memoria%20donantes%202015.pdf.
- 23Hart A, Smith JM, Skeans MA, et al. OPTN/SRTR 2015 Annual Data Report: Kidney Am J Transplant 2017 Jan; 17Suppl 1: 21.
- 24Doshi MD, Reese PP, Hall IE. Utility of applying quality assessment tools for kidneys with KDPI ≥80. Transplantation 2016; Epub ahead of print. https://doi.org/10.1097/tp.0000000000001388.
- 25Pascual J, Pérez-Sáez MJ. Kidney donor profile index: can it be extrapolated to our enviroment? Nefrologia 2016; 36: 465.
- 26Haas M, Segev DL, Racusen LC, et al. Arteriosclerosis in kidneys from healthy live donors. Comparison of wedge and needle core perioperative biopsies. Arch Pathol Lab Med 2008; 132: 37.
- 27Losappio V, Stallone G, Infante B, et al. A single-center cohort study to define the role of pretransplant biopsy score in the long-term outcome of kidney transplantation. Transplantation 2014; 97: 934.
- 28Kosmoliaptsis V, Salji M, Bardsley V, et al. Baseline donor chronic renal injury confers the same transplant survival disadvantage for DCD and DBD kidneys. Am J Transplant 2015; 15: 754.
- 29Hass M. Donor kidney biopsies: pathology matters and so does the pathologist. Kidney Int 2014; 85: 1016.
- 30Carta P, Zanazzi M, Caroti L, et al. Impact of the pre-transplant histological score on 3-year graft outcomes of kidneys from marginal donors: a single-centre study. Nephrol Dial Transplant 2013; 28: 2637.
- 31Navarro MD, Lopez-Andreu M, Rodriguez-Benot A, et al. Significance of preimplantation analysis of kidney biopsies from expanded criteria donors in long-term outcome. Transplantation 2011; 91: 432.
- 32Mazzucco G, Magnani C, Fortunato M, Todesco A, Monga G. The reliability of pre-transplant donor renal biopsies (PTDB) in predicting the kidney state. A comparative single-centre study on 154 untransplanted kidneys. Nephrol Dial Transplant 2010; 25: 3401.
- 33Pérez-Sáez MJ, Montero N, Redondo-Pachón D, Crespo M, Pascual J. Strategies for an expanded use of kidneys from elderly donors. Transplantation 2017; 101: 727. https://doi.org/10.1097/TP.0000000000001635.
- 34Massie AB, Luo X, Chow EK, et al. Survival benefit of primary deceased donor transplantation with high-KDPI kidneys. Am J Transp 2014; 14: 2310.
- 35Jay CL, Washburn K, Dean PG, Helmick RA, Pugh JA, Stegall MD. Survival benefit in older patients associated with earlier transplant with high KDPI kidneys. Transplantation 2016; 101: 867.
- 36Molnar MZ, Streja E, Kovesdy CP, et al. Age and the associations of living donor and expanded criteria donor kidney with kidney transplant outcomes. Am J Kidney Dis 2012; 59: 841.
- 37Tullius SG, Tran H, Guleria I, et al. The combination of donor and recipient age is critical in determining host immunoresponsiveness and renal transplant outcome. Ann Surg 2010; 252: 662.
- 38Hernandez RA, Malek SK, Milford EL, Finlayson SR, Tullius SG. The combined Risk of donor quality and recipient age: higher-quality kidneys may not always improve patient and graft survival. Trasplantation 2014; 98: 1069.
- 39Heldal K, Hartmann A, Leivestad T, et al. Clinical outcomes in elderly kidney transplant recipients are related to acute rejection episodes rather than pretransplant comorbidity. Transplantation 2009; 87: 1045.
