Kidney Week

Abstract: FR-PO0969

Deceased-Donor Kidney Procurement Biopsy Practices: Cohort Study of Trends, Clinical Correlations, and Organ Use

Session Information

• Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States

Krista L. Lentine, MD, PhD, FASN

• Caza, Tiffany, Arkana Laboratories, Little Rock, Arkansas, United States

Tiffany Caza, MD, PhD

• Mannon, Roslyn B., University of Nebraska Medical Center, Omaha, Nebraska, United States

Roslyn B. Mannon, MD, FASN

• Caliskan, Yasar, Saint Louis University, St. Louis, Missouri, United States

Yasar Caliskan, MD

• Alhamad, Tarek, Washington University in St Louis, St. Louis, Missouri, United States

Tarek Alhamad, MD, MBA, MPH, FASN

• Wellen, Jason, Washington University in St Louis, St. Louis, Missouri, United States

Jason Wellen, MD, MBA

• Axelrod, David, University Hospitals Health System, Cleveland, Ohio, United States

David Axelrod, MD, MBA

• Husain, Syed Ali, Columbia University, New York, New York, United States

Syed Ali Husain, MD, MA, MPH, FASN

• Mohan, Sumit, Columbia University, New York, New York, United States

Sumit Mohan, MD, MPH, FASN

• Marklin, Gary F., Mid-America Transplant Services, St. Louis, Missouri, United States

Gary F. Marklin, MD, MA

Background

We conducted a retrospective cohort study of deceased donor kidneys (DDK) procured at a U.S. organ procurement organization (OPO) to analyze trends, clinical correlates, biopsy findings, and associations with organ use.

Methods

We examined electronic records for DDK procured for transplant at a Midwestern OPO (2019-07/14/2023). Clinical correlates of procurement biopsy were assessed by multivariable logistic regression (adjusted odds ratio, _LCLaOR_UCL). DDK utilization was compared in biopsied and non-biopsied groups over time. Frozen section findings were compared for transplanted vs. unused DDK (Chi-square test).

Results

Among 2,180 DDK procured for transplant, 56.5% were biopsied, tho rates declined over time (Fig). Donor age (aOR for >60 vs age <18, 1.131.702.66), DCD status (aOR, _1.311.61_1.97) and KPDI 65+ (aOR, _1.131.30_2.66) were the strongest correlates of undergoing biopsy, while the adjusted likelihood of biopsy declined over time (aOR for 2022-2023 vs 2019, _0.580.75 _0.96). Non-use was more common in biopsied DDK overall (26.7% vs 5.8% in non-biopsied). Non-used DDK had higher proportions of biopsy findings across compartments (Table). Non-use after biopsy did not decline over time (26% in 2023 vs 21% in 2019).

Conclusion

DDK procurement biopsies are frequently performed and are linked to higher rates of organ non-use. While biopsy and utilization patterns are influenced by the selection of higher-risk donor characteristics and associated histopathological findings, temporal trends indicate that biopsy rates may decline with shifts in local practices. Further research should assess whether reducing biopsy rates can decrease organ non-use while maintaining acceptable transplant outcomes.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025wpqye88q