Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Feb 15;14(2):254.
doi: 10.3390/life14020254.

The Puzzle of Preimplantation Kidney Biopsy Decision-Making Process: The Pathologist Perspective

Albino Eccher  1 , Jan Ulrich Becker  2 , Fabio Pagni  3 , Giorgio Cazzaniga  3 , Mattia Rossi  4 , Giovanni Gambaro  4 , Vincenzo L'Imperio  3 , Stefano Marletta  5   6
Affiliations
Review

The Puzzle of Preimplantation Kidney Biopsy Decision-Making Process: The Pathologist Perspective

Albino Eccher et al. Life (Basel). .

Abstract

Kidney transplantation is the best treatment for end-stage renal disease since it offers the greatest survival benefit compared to dialysis. The gap between the number of renal transplants performed and the number of patients awaiting renal transplants leads to a steadily increasing pressure on the scientific community. Kidney preimplantation biopsy is used as a component of the evaluation of organ quality before acceptance for transplantation. However, the reliability and predictive value of biopsy data are controversial. Most of the previously proposed predictive models were not associated with graft survival, but what has to be reaffirmed is that histologic examination of kidney tissue can provide an objective window on the state of the organ that cannot be deduced from clinical records and renal functional studies. The balance of evidence indicates that reliable decisions about donor suitability must be made based on the overall picture. This work discusses recent trends that can reduce diagnostic timing and variability among players in the decision-making process that lead to kidney transplants, from the pathologist's perspective.

Keywords: kidney transplant; pathologist; preimplantation kidney biopsy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Histopathological picture of renal cortex in pre-implantation core-needle (A) and wedge biopsies (B), this latter highlighting several normal glomeruli (top left, blue arrow), a sclerotic glomerulus (bottom right, blue circle), and an arterial vessel with parietal calcifications (centre, red arrow).
Figure 2
Figure 2
The interconnected players of the preimplantation kidney biopsy puzzle and their flow. Legend: “?”: still missing.
Figure 3
Figure 3
The digital pathology workflow: conventional histological slides are scanned to whole slide imaging (WSI) and then visualized on a computer monitor where they can be freely manipulated (rotated, zoomed in and out, etc…) by pathologists, eventually with the support of artificial intelligence (AI) tools.
See this image and copyright information in PMC

References

    1. Villanego F., Vigara L.A., Cazorla J.M., Naranjo J., Atienza L., Garcia A.M., Montero M.E., Minguez M.C., Garcia T., Mazuecos A. Evaluation of Expanded Criteria Donors Using the Kidney Donor Profile Index and the Preimplantation Renal Biopsy. Transpl. Int. Off. J. Eur. Soc. Organ Transplant. 2022;35:10056. doi: 10.3389/ti.2022.10056. - DOI - PMC - PubMed
    1. Reese P.P., Aubert O., Naesens M., Huang E., Potluri V., Kuypers D., Bouquegneau A., Divard G., Raynaud M., Bouatou Y., et al. Assessment of the Utility of Kidney Histology as a Basis for Discarding Organs in the United States: A Comparison of International Transplant Practices and Outcomes. J. Am. Soc. Nephrol. 2021;32:397–409. doi: 10.1681/ASN.2020040464. - DOI - PMC - PubMed
    1. Zaza G., Cucchiari D., Becker J.U., de Vries A.P.J., Eccher A., Florquin S., Kers J., Rabant M., Rossini M., Pengel L., et al. 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. Off. J. Eur. Soc. Organ Transplant. 2023;36:11410. doi: 10.3389/ti.2023.11410. - DOI - PMC - PubMed
    1. Haas M. Donor kidney biopsies: Pathology matters, and so does the pathologist. Kidney Int. 2014;85:1016–1019. doi: 10.1038/ki.2013.439. - DOI - PubMed
    1. Nyberg S.L., Matas A.J., Kremers W.K., Thostenson J.D., Larson T.S., Prieto M., Ishitani M.B., Sterioff S., Stegall M.D. Improved scoring system to assess adult donors for cadaver renal transplantation. Am. J. Transplant. Off. J. Am. Soc. Transplant. Am. Soc. Transpl. Surg. 2003;3:715–721. doi: 10.1034/j.1600-6143.2003.00111.x. - DOI - PubMed

LinkOut - more resources