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Abstract: SA-PO818

Transplant or Discard: Pathology From a Single Biopsy Should Not Influence Decision to Discard

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Muzyka, Stephen Charles, University of Virginia, Charlottesville, Virginia, United States
  • Oxley, Gavin Thomas, University of Virginia, Charlottesville, Virginia, United States
  • Morrison, Hannah, University of Virginia, Charlottesville, Virginia, United States
  • Cathro, Helen P., UVA Health, Charlottesville, Virginia, United States
  • Deronde, Kimberly, University of Virginia Children's Hospital, Charlottesville, Virginia, United States
  • Cwiek, Aleksandra, University of Virginia, Charlottesville, Virginia, United States
  • Bennett, Kevin M., Washington University in St Louis, St Louis, Missouri, United States
  • Charlton, Jennifer R., University of Virginia Children's Hospital, Charlottesville, Virginia, United States
Background

Thousands of patients die awaiting a transplant, while 20% of kidneys are discarded. Glomerulosclerosis (GS) and interstitial fibrosis with tubular atrophy (IFTA) are the main reasons to discard kidneys. Histologic risk scores have been developed, but assume a single biopsy represents the whole kidney. The variance of pathology from high risk kidneys, representing the reproducibility of a decision to transplant based on biopsy, has not been evaluated. Here, we measured the variance of pathology in KPDI≥85 kidneys to determine the effect on discard decisions.

Methods

Kidneys unsuitable for transplant (some non-renal reasons) were acquired (n=26, 18 donors). KDPI was calculated. Three needle biopsies were performed. A renal pathologist identified GS. IFTA was measured with Amira software.

Results

Table 1 has donor demographics. The intra- and inter-kidney variance of GS was large (Figure). There was no difference in the %GS or variance in those with KDPI<85 vs ≥85 (p=0.65). Four KDPI≥85 kidneys had GS scores of ≤20% in all biopsies. IFTA variance was greater in KDPI<85 vs. ≥ 85 (p=0.02).

Conclusion

A single biopsy does not represent whole kidney pathology. Pathologic findings from a single biopsy should not guide decisions to discard potenitally suitable kidneys. These data, and observations that biopsy findings do not predict transplant outcomes, highlight the need for tools to measure whole kidney pathology to identify transplantable kidneys.

 KDPI<85% (n=9)KDPI≥85% (n=17)
sex (male, %)8924
age (mean±SD)49±767±9
ethnicity (white, %)8959
hypertension (yes, %)2273
diabetes (yes, %)020
pair of kidneys (#)26

Funding

  • NIDDK Support