Journal article
Deceased Donor Procurement Biopsy Practices, Interpretation, and Histology-Based Decision-Making: A Survey of US Kidney Transplant Centers
Kidney international reports, Vol.7(6), pp.1268-1277
06/2022
DOI: 10.1016/j.ekir.2022.03.021
PMCID: PMC9171615
PMID: 35685316
Abstract
The utility of kidney procurement biopsies is controversial. Understanding the current landscape of how clinicians obtain and use biopsies in organ evaluation may help inform consensus-building efforts.
An electronic survey was distributed to clinicians at US kidney transplant programs (April 22, 2021–June 30, 2021) to evaluate donor biopsy indications, frequency, processing and interpretation, and impact of findings on practices.
Responses from staff involved in organ acceptance (73% surgeons, 20% nephrologists, 6% coordinators) at 95 transplant centers were analyzed, representing 40% of US transplant centers and 50% of recent deceased donor kidney transplant volume. More than a third of centers (35%) reported obtaining procurement biopsies on most-to-all kidneys. Most clinicians decided when to biopsy jointly with the Organ Procurement Organization (OPO) (82%) based on formal criteria for the decision (72%), although 41% reported having requested a biopsy outside of the criteria. Most respondents used a semiquantitative scoring system for interpretation (57%). Many respondents reported rarely or never having access to renal specialty pathologists (37%) or to telepathology (59%). Most respondents reported that a favorable biopsy result would encourage them to accept a "marginal" donor kidney (72%); nearly half (46%) indicated that an unfavorable biopsy result would lead to decline of a standard criteria kidney.
Procurement biopsies are commonly used in organ acceptance decisions despite inconsistent access to experienced renal pathologists and heterogeneous approaches to criteria, scoring, and interpretation. Ongoing study and consensus building are needed to direct procurement biopsy practice toward increasing organ utilization and reducing allocation inefficiency.
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Details
- Title: Subtitle
- Deceased Donor Procurement Biopsy Practices, Interpretation, and Histology-Based Decision-Making: A Survey of US Kidney Transplant Centers
- Creators
- Krista L. Lentine - Saint Louis UniversityVidya A. Fleetwood - Saint Louis UniversityYasar Caliskan - Saint Louis UniversityHenry Randall - Saint Louis UniversityJason R. Wellen - Washington University in St. LouisMelissa Lichtenberger - Washington University in St. LouisCraig Dedert - Saint Louis UniversityRichard Rothweiler - Mid-America Transplant, St. Louis, MOGary Marklin - Mid-America Transplant, St. Louis, MODiane Brockmeier - Mid-America Transplant, St. Louis, MOMark A. Schnitzler - Saint Louis UniversitySyed A. Husain - Columbia UniversitySumit Mohan - Columbia UniversityBertram L. Kasiske - Hennepin County Medical CenterMatthew CooperRoslyn B. Mannon - University of Nebraska at OmahaDavid A. Axelrod - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Kidney international reports, Vol.7(6), pp.1268-1277
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.ekir.2022.03.021
- PMID
- 35685316
- PMCID
- PMC9171615
- ISSN
- 2468-0249
- eISSN
- 2468-0249
- Language
- English
- Date published
- 06/2022
- Academic Unit
- Surgery
- Record Identifier
- 9984322939802771
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