Abstract: TH-OR129
Absence of Additional Predictive Ability Value of Preimplantation Biopsies for Long-Term Allograft Outcome
Session Information
- Policy and Pretransplant Considerations
November 07, 2019 | Location: 151, Walter E. Washington Convention Center
Abstract Time: 04:42 PM - 04:54 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Aubert, Olivier, Paris Translational Research Center for Organ Transplantation, Paris, France
- Raynaud, Marc, Paris Translational Research Center for Organ Transplantation, Paris, France
- Divard, Gillian, Paris Translational Research Center for Organ Transplantation, Paris, France
- Bouatou, Yassine R., Paris Translational Research Center for Organ Transplantation, Paris, France
- Glotz, Denis, Hopital Saint-Louis, Paris, France
- Legendre, Christophe M., Hôpital Necker, Paris, France
- Lefaucheur, Carmen, Saint-Louis Hospital, Paris, France
- Reese, Peter P., University of Pennsylvania, Ardmore, Pennsylvania, United States
- Loupy, Alexandre, Paris Translational Research Center for Organ Transplantation, Paris, France
Background
A significant number of kidneys are discarded worldwide due to the suboptimal use of large kidney resources. The main cause of discard is the result of the preimplantation biopsy.
Methods
We included patients who underwent kidney transplantations from a deceased donor in 2 French referral centers between 2004 and 2014 with preimplantation biopsy. Two external validation cohorts were included: 1,107 deceased donors from Belgium and 1,103 discarded kidneys based on biopsy results from the US.
Results
A total of 1,629 patients were included in the development cohort. After adjusting for donor, recipient, and transplant characteristics as well as for preimplantation biopsy findings (IFTA, cv and ah Banff score, and glomerulosclerosis percentage) and baseline immunological parameters, we identified the KDRI score (HR=2.50; 95% CI, (1.38 to 3.40); p<0.001), the presence of circulating DSA on the day of transplantation (HR=1.76; 95% CI, (1.36 to 2.28); p<0.001), prior kidney transplantation (HR=1.34; 95% CI, (1.01 to 1.78); p=0.045), and the IFTA score (HR=1.51; 95% CI, (1.00 to 2.26); p=0.048) as the main independent determinants of long-term allograft loss. However, the biopsy results had no additional value to predict long term allograft outcome when compared to the model without the biopsy results. In the Belgium validation cohort, none of the biopsy results were associated with allograft loss. Kidneys discarded based on histology results in the US were matched to transplanted kidneys in France. French kidneys with similar histological results as discarded kidneys in the US did not have worse allograft survival compared to the unmatched transplanted kidneys (p=0.156).
Conclusion
Given this result and the fact that preimplantation biopsies increase the cold ischemia time, the current practice of discarding kidneys based on preimplantation biopsy results may not be optimal for allocation decision-making.