Premium
Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation
Author(s) -
Lentine Krista L.,
Naik Abhijit S.,
Schnitzler Mark A.,
Randall Henry,
Wellen Jason R.,
Kasiske Bertram L.,
Marklin Gary,
Brockmeier Diane,
Cooper Matthew,
Xiao Huiling,
Zhang Zidong,
Gaston Robert S.,
Rothweiler Richard,
Axelrod David A.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15325
Subject(s) - medicine , biopsy , odds ratio , opos , organ procurement , odds , transplantation , surgery , urology , pathology , logistic regression , physics , nonlinear system , quantum mechanics , nonlinear optics
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.