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Kidney Week

Abstract: TH-PO1120

Prognostic Value of Standardized Deceased Donor Kidney (DDK) Procurement Biopsies

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Alvarado verduzco, Hector, Columbia University Medical Center, New York, New York, United States
  • King, Kristen L., Columbia University Medical Center, New York, New York, United States
  • Batal, Ibrahim, New York Presbyterian Hospital (Columbia Campus) , New York, New York, United States
  • Mohan, Sumit, Columbia University, New York, New York, United States
  • Husain, Syed Ali, Columbia University Medical Center, New York, New York, United States
Background

Procurement biopsy (PBx) histology is the most common reason for DDK discard but has been shown to be of limited prognostic value. Occasionally DDK are biopsied twice when transported between OPOs, allowing us to assess the standardized approach to performing and interpreting PBx at our OPO.

Methods

We identified 591 DDKs transplanted at our center from 1/2006-12/2016 (imported from 60 OPOs) with an initial PBx (PBx1) that was repeated by our local OPO (PBx2). “Suboptimal histology” was defined as glomerulosclerosis (GS)>10%, interstitial fibrosis/tubular atrophy (IFTA)>25%, and/or vascular disease (VD) graded as moderate or severe. We calculated kappa coefficients to assess agreement between PBx and used time-to-event analyses to evaluate the association between suboptimal histology on PBx1 and PBx2 with death-censored allograft survival.

Results

36% PBx1 and 17% PBx2 were classified as having suboptimal histology. 75% of DDK with suboptimal PBx1 had optimal PBx2. Overall histologic concordance (optimal versus suboptimal) between PBx1 and PBx2 was 65% (κ =0.13). Categorical agreement was higher for VD (κ=0.13, 52% concordance) than for IFTA (κ=0.08, 67% concordance) or GS (κ=0.11, 44% concordance). In contrast to PBx1, suboptimal PBx2 histology was associated with death-censored allograft survival in bivariable and multivariable analysis (adjusted hazard ratio 2.17, 95% CI 1.72-3.45, p<0.001).

Conclusion

PBx performed at different OPOs were frequently discordant, likely due to variable PBx technique and interpretation between OPOs. Our results suggest that standardization may improve utility and reliability of PBx for assessing DDK quality.