Wasting the Gift of Life?
Our discard rates for donated kidneys are at their highest ever, thanks in part to unreliable and inconsistent procurement biopsies that need to be re-examined. How can we do better?
Sumit Mohan | | Longer Read
At a Glance
- Many donor kidneys are discarded due to the findings of procurement biopsies
- These biopsies have issues with accuracy and consistency and are often read by pathologists with limited renal experience
- In our study, the findings of multiple procurement biopsies on the same kidney showed only a 64 percent agreement rate
- Standardization – and limiting our reliance on procurement biopsies – will lead to an increase in transplantation rates
Once a potential kidney donor has been identified, a simple but crucial question arises. Should the organ be accepted for transplant – or turned away? Factors such as donor and recipient characteristics, anatomic and immunologic information, and longevity matching considerations all influence this call and must be considered quickly. To help inform the decision, surgeons carry out procurement biopsies while the organ is being obtained; these occur in around half of all deceased-donor kidneys in the US (1). Deceased donor kidneys are a scarce and valuable resource – but, alarmingly, we find ourselves facing the highest kidney discard rate of all time, with one in five donated organs going to waste (2, 3). The findings of procurement biopsies play a telling role in these rates; they are listed as the main reason for discard in around 37 percent of kidneys that are procured but ultimately not used (4).
With the results of procurement biopsies contributing so heavily to the discard of potentially transplantable kidneys, it is vital to cast a critical eye over their efficacy at identifying organs that shouldn’t be transplanted. A number of analyses have already raised questions about the reproducibility and predictive value of procurement biopsies, so we conducted our own study to assess their reliability (4). Across 116 kidneys that had undergone multiple procurement biopsies, we found only a 64 percent agreement rate between different biopsies, suggesting low reliability and consistency when it comes to the information that they present. A similar agreement was found between procurement biopsies and gold-standard reperfusion biopsies performed after kidney implantation.
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