RT Journal Article
SR Electronic
T1 Assessment of the Utility of Kidney Histology as a Basis for Discarding Organs in the United States: A Comparison of International Transplant Practices and Outcomes
JF Journal of the American Society of Nephrology
JO J. Am. Soc. Nephrol.
FD American Society of Nephrology
SP 397
OP 409
DO 10.1681/ASN.2020040464
VO 32
IS 2
A1 Reese, Peter P.
A1 Aubert, Olivier
A1 Naesens, Maarten
A1 Huang, Edmund
A1 Potluri, Vishnu
A1 Kuypers, Dirk
A1 Bouquegneau, Antoine
A1 Divard, Gillian
A1 Raynaud, Marc
A1 Bouatou, Yassine
A1 Vo, Ashley
A1 Glotz, Denis
A1 Legendre, Christophe
A1 Lefaucheur, Carmen
A1 Jordan, Stanley
A1 Empana, Jean-Philippe
A1 Jouven, Xavier
A1 Loupy, Alexandre
YR 2021
UL http://jasn.asnjournals.org/content/32/2/397.abstract
AB Many kidneys donated for transplantation are discarded because of abnormal histology, but it is unknown whether preimplantation kidney biopsies that are routinely performed in the United States add incremental value beyond usual donor attributes in predicting allograft survival. The investigators analyzed detailed data from transplant centers in France and Belgium, where pretransplant biopsies are prospectively performed as standard practice but do not guide decision making for organ allocation. They found that transplant histology did not improve the prediction of allograft failure beyond a robust baseline set of donor and recipient characteristics. They also studied donor kidneys from deceased United States donors—specifically, organs discarded because of abnormal histology—and matched them with similar kidneys transplanted in Europe. The matched kidneys had acceptable allograft survival, illustrating lost transplant opportunities in the United States.Background Many kidneys donated for transplant in the United States are discarded because of abnormal histology. Whether histology adds incremental value beyond usual donor attributes in assessing allograft quality is unknown.Methods This population-based study included patients who received a deceased donor kidney that had been biopsied before implantation according to a prespecified protocol in France and Belgium, where preimplantation biopsy findings are generally not used for decision making in the allocation process. We also studied kidneys that had been acquired from deceased United States donors for transplantation that were biopsied during allocation and discarded because of low organ quality. Using donor and recipient characteristics, we fit multivariable Cox models for death-censored graft failure and examined whether predictive accuracy (C index) improved after adding donor histology. We matched the discarded United States kidneys to similar kidneys transplanted in Europe and calculated predicted allograft survival.Results In the development cohort of 1629 kidney recipients at two French centers, adding donor histology to the model did not significantly improve prediction of long-term allograft failure. Analyses using an external validation cohort from two Belgian centers confirmed the lack of improved accuracy from adding histology. About 45% of 1103 United States kidneys discarded because of histologic findings could be accurately matched to very similar kidneys that had been transplanted in France; these discarded kidneys would be expected to have allograft survival of 93.1% at 1 year, 80.7% at 5 years, and 68.9% at 10 years.Conclusions In this multicenter study, donor kidney histology assessment during allocation did not provide substantial incremental value in ascertaining organ quality. Many kidneys discarded on the basis of biopsy findings would likely benefit United States patients who are wait listed.