Procurement Biopsies in the Evaluation of Deceased Donor Kidneys

Abstract

Background and objectives: Biopsies 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, & measurements: We 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).

Results: For 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.

Conclusions: We found that procurement biopsies are poorly reproducible, do not correlate well with paraffin-embedded reperfusion biopsies, and are not significantly associated with transplant outcomes.

Keywords: Allografts; Atrophy; Biopsy; Follow-Up Studies; Frozen Sections; Graft Survival; Kidney Diseases; Paraffin Embedding; Pathologists; Prognosis; Reproducibility of Results; Retrospective Studies; Tissue Donors; Vascular Diseases; kidney; kidney biopsy; kidney transplantation; transplant pathology; transplantation.

Graphical abstract

Figure 1.

Flow chart for procurement/reperfusion biopsy cohorts. CUMC, Columbia University Medical Center; IFTA, interstitial fibrosis/tubular atrophy; Tx, transplant. *Agreement between procurement and reperfusion biopsies. **Agreement between sequential procurement biopsies.

Figure 2.

Unadjusted Kaplan–Meier curves for the final Cox model exposure and outcome. In contrast to reperfusion biopsy histology, procurement biopsy histology is not significantly associated with allograft failure.