Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
Krista L LentineDavid A Axelrod

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 aOR95%UCL ], 3.29 3.513.76 ). This association was most pronounced for low-risk (KDPI <20) kidneys (aOR, 5.45 6.477.69 ), with minimal impact at KDPI >85 (aOR, 0.88 1.151.51 ). Adjusted MORs for kidney discard and biopsy were greatest for low-risk kidneys. Reducing the rat...Continue Reading

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Citations

Aug 27, 2019·JAMA Internal Medicine·Ryoichi Maenosono, Stefan G Tullius
Jan 31, 2020·Clinical Transplantation·Farrukh M KoraishyKrista L Lentine
Nov 27, 2019·Clinical and Experimental Nephrology·Evaldo FaviRoberto Cacciola
Mar 27, 2020·Journal of Clinical Medicine·Julie De Beule, Ina Jochmans
Sep 17, 2020·Transplant International : Official Journal of the European Society for Organ Transplantation·James Neuberger, Chris Callaghan
May 29, 2021·Journal of the American Society of Nephrology : JASN·Krista L LentineDavid A Axelrod
Aug 1, 2021·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Krista L LentineDavid A Axelrod
Sep 22, 2021·Current Opinion in Nephrology and Hypertension·Paresh JadavSyed Ali Husain
Nov 12, 2021·Journal of the American Society of Nephrology : JASN·Darya MorozovKevin M Bennett

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