Journal article
Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation
American journal of transplantation, Vol.19(8), pp.2241-2251
08/01/2019
DOI: 10.1111/ajt.15325
PMID: 30809941
Abstract
The use of procurement biopsies in deceased donor kidney acceptance is controversial. We analyzed Scientific Registry of Transplant Recipients data (n = 59 328 allografts, 2014-2018) to describe biopsy practices across US organ procurement organizations (OPOs) and examine relationships with discards, using hierarchical modeling to account for OPO and donor factors. Median odds ratios (MORs) provide the median of the odds that allografts with identical reported traits would be biopsied or discarded from 2 randomly drawn OPOs. Biopsies were obtained for 52.7% of kidneys. Biopsy use rose in a graded manner with kidney donor profile index (KDPI). Biopsy rates differed significantly among OPOs (22.8% to 77.5%), even after adjustment for KDPI and other donor factors. Discard rates also varied from 6.6% to 32.1% across OPOs. After adjustment for donor factors and OPO, biopsy was associated with more than 3 times the likelihood of discard (adjusted odds ratio [(95%LCL)aOR(95)(%UCL)], (3.29)3.51(3.76)). This association was most pronounced for low-risk (KDPI <20) kidneys (aOR, (5.45)6.47(7.69)), with minimal impact at KDPI >85 (aOR, (0.88)1.15(1.51)). Adjusted MORs for kidney discard and biopsy were greatest for low-risk kidneys. Reducing the rate of unnecessary biopsy and improving the accuracy of histologic assessments in higher KDPI organs may help reduce graft discard rates.
Details
- Title: Subtitle
- Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation
- Creators
- Krista L. Lentine - St Louis Univ, Ctr Abdominal Transplantat, St Louis, MO 63103 USAAbhijit S. Naik - University of MichiganMark A. Schnitzler - Saint Louis UniversityHenry Randall - Saint Louis UniversityJason R. Wellen - Washington University in St. LouisBertram L. Kasiske - Hennepin Healthcare Research InstituteGary Marklin - Mid‐America Transplant St. Louis MissouriDiane Brockmeier - Mid‐America Transplant St. Louis MissouriMatthew Cooper - MedStar Georgetown University HospitalHuiling Xiao - Saint Louis UniversityZidong Zhang - Saint Louis UniversityRobert S. Gaston - Clinical Trial and ConsultingRichard Rothweiler - Mid‐America Transplant St. Louis MissouriDavid A. Axelrod - University of Iowa
- Resource Type
- Journal article
- Publication Details
- American journal of transplantation, Vol.19(8), pp.2241-2251
- DOI
- 10.1111/ajt.15325
- PMID
- 30809941
- NLM abbreviation
- Am J Transplant
- ISSN
- 1600-6135
- eISSN
- 1600-6143
- Publisher
- Wiley
- Number of pages
- 11
- Grant note
- HHSH250201000018C / Health Resources and Services Administration; United States Department of Health & Human Services; United States Health Resources & Service Administration (HRSA)
- Language
- English
- Date published
- 08/01/2019
- Academic Unit
- Surgery
- Record Identifier
- 9984322804702771
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