Influence of organ quality on the observed association between deceased donor kidney procurement biopsy findings and graft survival

• Published in: American journal of transplantation Vol. 22; no. 12; pp. 2842 - 2854
• Main Authors: Husain, S. Ali, King, Kristen L., Cron, David C., Lentine, Krista L., Adler, Joel T., Mohan, Sumit
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01-12-2022
• Subjects: Biopsy; Creatinine; Death; Donor Selection; Graft rejection; Graft Survival; Grafts; Histology; Humans; Kidney - pathology; kidney biopsy; kidney donor; Kidney Transplantation; Kidney transplants; Kidneys; Organ donors; Renal failure; Retrospective Studies; Tissue and Organ Procurement; Tissue Donors; transplant outcomes; United States; Vascular diseases; United States; kidney biopsy; kidney donor; transplant outcomes; kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.17167

Deceased donor kidney procurement biopsies findings are the most common reason for kidney discard. Retrospective studies have found inconsistent associations with post‐transplant outcomes but may have been limited by selection bias because kidneys with advanced nephrosclerosis from high‐risk donors are typically discarded. We conducted a retrospective cohort study of kidneys transplanted in the United States from 2015 to 2019 with complete biopsy data available, defining “suboptimal histology” as glomerulosclerosis ≥11%, IFTA ≥mild, and/or vascular disease ≥mild. We used time‐to‐event analyses to determine the association between suboptimal histology and death‐censored graft failure after stratification by kidney donor profile index (KDPI) (≤35%, 36%–84%, ≥85%) and final creatinine (<1 mg/dl, 1–2 mg/dl, >2 mg/dl). Among 30 469 kidneys included, 36% had suboptimal histology. In adjusted analyses, suboptimal histology was associated with death‐censored graft failure among kidneys with KDPI 36–84% (HR 1.22, 95% CI 1.09–1.36), but not KDPI≤35% (HR 1.24, 0.94–1.64) or ≥ 85% (HR 0.99, 0.81–1.22). Similarly, suboptimal histology was associated with death‐censored graft failure among kidneys from donors with creatinine 1‐2 mg/dl (HR 1.39, 95% CI 1.20–1.60) but not <1 mg/dl (HR 1.07, 0.93–1.23) or >2 mg/dl (HR 0.95, 0.75–1.20). The association of procurement histology with graft longevity among intermediate‐quality kidneys that were likely to be both biopsied and transplanted suggests biopsies provide independent organ quality assessments.
This retrospective analysis of U.S. registry data demonstrates that deceased donor kidney procurement biopsy findings are associated with post‐transplant outcomes in a subset of kidneys that are likely to be both biopsied and transplanted.