Abstract: FR-PO1019

Contralateral Deceased Donor Kidney Procurement Biopsy Predicts Allograft Outcomes

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Husain, Syed Ali, Columbia University Medical Center, New York, New York, United States
  • Carpenter, Dustin, Columbia University , New York City, New York, United States
  • Rosen, Raphael, New York Presbyterian - Columbia, New York, New York, United States
  • Santoriello, Dominick, Columbia University Medical Center, New York, New York, United States
  • Chiles, Mariana C., Columbia University Medical Center, New York, New York, United States
  • Dale, Leigh-Anne, New York Presbyterian Columbia, New York, New York, United States
  • Ratner, Lloyd E., Columbia University , New York City, New York, United States
  • Mohan, Sumit, Columbia University , New York City, New York, United States
Background

Deceased donor kidney (DDK) procurement biopsies are often used to assess organ quality but have limited ability to predict outcomes, likely due to sampling error. We studied whether combining bilateral kidney biopsy results improves the prediction of allograft survival.

Methods

We identified all DDKs transplanted at our center from 2005-2009 that had procurement biopsies performed. Biopsy results from these kidneys and their contralateral partners (if available) were obtained from donor charts. Histology was classified as optimal if glomerulosclerosis (GS)≤10%, interstitial fibrosis/tubular atrophy (IFTA)≤10%, and vascular disease was none/mild. We compared death-censored graft failure for kidneys based on histologic category.

Results

256 donors had a procurement biopsy on both kidneys, among whom 80.1% had concordant bilateral histologic categorization (99 both optimal, 106 both suboptimal) (κ=0.60, p<0.001). Agreement was higher for IFTA and vascular disease (both 75.8%) than GS (58.6%). When bilateral kidney biopsy results were combined, death-censored graft failure was highest for suboptimal kidneys with suboptimal partners, lower if only one kidney in the pair had optimal histology, and lowest for optimal kidneys with optimal partners (p=0.03) (Figure1). 43 kidneys (16.8%) had contralateral partners that were discarded. Discarded contralateral kidneys were more likely to have GS>5% (58.1% v 38.0%, p=0.02), as were their transplanted partners (60.5% v 41.3%, p=0.02). IFTA and vascular disease were not associated with discard. Partner discard did not predict transplanted kidney outcomes beyond biopsy results.

Conclusion

Adding contralateral kidney biopsy findings to DDK procurement biopsy appears to improve predictive power. When available, contralateral kidney biopsy findings should be provided to clinicians as part of the organ offer.