Biopsies before transplantation do not determine success of donated kidneys

February 20, 2014

Biopsies of donated kidneys provide little information for determining the suitability of organs for transplantation, according to two studies appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings suggest that other methods are needed when weighing whether to discard or transplant a deceased donor kidney.

The quality of donated kidneys is fundamentally important for the longevity of kidney transplants. Clinicians often use to assess kidney health before transplantation. Chirag Parikh, MD, PhD and Isaac Hall, MD, MS (Yale University and Veterans Affairs Medical Center) led a team that looked for associations between -reported at the time of with subsequent outcomes. "We were hoping to expand our knowledge about these associations and explain inconsistent findings in the medical literature by performing the largest multicenter study of its kind to date," said Dr. Hall.

Between March 2010 and April 2012, the researchers biopsied 651 kidneys (taken from 369 donors through four organ procurement organizations) that were subsequently transplanted into recipients. The team found that biopsy-reported kidney injury was modestly associated with a delay in organ function in the first week after transplantation, but only for a subgroup of donor kidneys already known to be at high risk for this early outcome. The investigators also found that biopsies frequently underreported acute kidney injury with substantial variability.

"Biopsies are listed as the primary reasons for discarding deceased-donor kidneys; however, as they currently relate to reported , they provide little utility for determining the overall risk of delayed organ function or even premature organ failure," said Dr. Parikh.

In another study, Bertram Kasiske, MD (Scientific Registry of Transplant Recipients and Hennepin County Medical Center) and his colleagues compared the results of biopsies from kidneys that were discarded with the results of biopsies from comparable kidneys that were successfully transplanted. In particular, the researchers compared biopsies of both kidneys from the same donor, when one kidney was transplanted and the other was discarded. The analysis included biopsy reports from 83 kidneys discarded due to biopsy findings, 83 contralateral transplanted kidneys from the same donor, and 83 deceased donors randomly matched to cases by donor risk profile.

The team found that there was a large degree of overlap between the results of biopsies from kidneys that were discarded and kidneys that were transplanted. The researchers also found that the quality of the biopsies used in acceptance decisions was low. The percentage of glomeruli (the filtering units of the kidney) that were scarred was most often used to decide whether kidneys were discarded or transplanted; however, this value was highly variable, even in biopsies from the same kidney.

Graft survival at one year was 80% for kidneys contralateral to discarded kidneys. This compares with one-year graft survival of 92% among all deceased donor kidney transplants in the Scientific Registry of Transplant Recipients. "If the discarded kidneys had been transplanted with the same graft survival as the transplanted kidneys from the opposite side, many patients may have benefited," said Dr. Kasiske. "Altogether these results question whether routine procurement biopsies result in discarding kidneys that could be acceptable for many of the patients who die waiting for a kidney transplant," he added.

In an editorial accompanying Dr. Kasiske's article, Sayeed Khan Malek, MD (Brigham and Women's Hospital) wrote, "When the biopsy findings are consistent with the clinical evaluation of the donor, they are useful in making the determination about transplanting the kidney. However, biopsy findings when considered in isolation are of limited value and should be interpreted with caution when making the decision to turn down a potentially transplantable kidney."

Explore further: Disparities exist in kidney transplant timing

More information: The article, entitled "Pre-implant Histologic Acute Tubular Necrosis and Allograft Outcomes," will appear online at cjasn.asnjournals.org/ on February 20, 2014.

The article, entitled "The Role of Procurement Biopsies in Acceptance Decisions for Kidneys Retrieved for Transplant," will appear online at cjasn.asnjournals.org/ on February 20, 2014.

The editorial, entitled "Procurement Biopsies in Kidneys Retrieved for Transplantation," will appear online at cjasn.asnjournals.org/ on February 20, 2014.

Related Stories

Disparities exist in kidney transplant timing

January 31, 2013
African-Americans and individuals without private health insurance are less likely than others to receive a kidney transplant before requiring dialysis, according to a study appearing in an upcoming issue of the Clinical ...

HIV can infect transplanted kidneys in HIV-positive recipients with undetectable virus

December 5, 2013
HIV can infect transplanted kidneys in HIV-positive recipients even in the absence of detectable virus in the blood, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology ...

Geography plays a major role in access to pediatric kidney transplantation in the US

January 16, 2014
A new study has revealed large geographic variation in waiting times for children across the United States in need of kidney transplants, with differences due mainly to local supply and demand. The findings, which will appear ...

Live donor's age has little effect on health of a transplanted kidney

March 22, 2012
People with kidney failure may think that they're better off getting a new kidney from a young and spry donor, but a recent study indicates that for those over 39 years old, the age of a live donor—ranging from 18 to ...

Study finds racial and social disparities in kidney allocation among young transplant recipients

October 10, 2013
Among younger kidney transplant recipients, a disproportionate number of African Americans and individuals with less education receive organs that are of lower quality or are considered marginal, according to a study appearing ...

Single gene variant in donors may affect survival of transplanted kidneys

October 11, 2012
A single genetic variant in kidney donors' cells may help determine whether their transplanted organs will survive long term, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology ...

Recommended for you

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

'bench to bedside to bench': Scientists call for closer basic-clinical collaborations

March 24, 2017
In the era of genome sequencing, it's time to update the old "bench-to-bedside" shorthand for how basic research discoveries inform clinical practice, researchers from The Jackson Laboratory (JAX), National Human Genome Research ...

The ethics of tracking athletes' biometric data

January 18, 2017
(Medical Xpress)—Whether it is a FitBit or a heart rate monitor, biometric technologies have become household devices. Professional sports leagues use some of the most technologically advanced biodata tracking systems to ...

Financial ties between researchers and drug industry linked to positive trial results

January 18, 2017
Financial ties between researchers and companies that make the drugs they are studying are independently associated with positive trial results, suggesting bias in the evidence base, concludes a study published by The BMJ ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.