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Reliability of deceased‐donor procurement kidney biopsy images uploaded in United Network for Organ Sharing
Author(s) -
Mansour Sherry G.,
Hall Isaac E.,
Reese Peter P.,
Jia Yaqi,
ThiessenPhilbrook Heather,
Moeckel Gilbert,
Weng Francis L.,
Revelo Monica P.,
Khalighi Mazdak A.,
Trivedi Anshu,
Doshi Mona D.,
Schröppel Bernd,
Parikh Chirag R.
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13441
Subject(s) - medicine , kappa , biopsy , inter rater reliability , fibrosis , radiology , pathology , linguistics , rating scale , psychology , developmental psychology , philosophy
Prior studies demonstrate poor agreement among pathologists’ interpretation of kidney biopsy slides. Reliability of representative images of these slides uploaded to the United Network of Organ Sharing (UNOS) web portal for clinician review has not been studied. We hypothesized high agreement among pathologists’ image interpretation, since static images eliminate variation induced by viewing different areas of movable slides. To test our hypothesis, we compared the assessments of UNOS‐uploaded images recorded in standardized forms by three pathologists. We selected 100 image sets, each having at least two images from kidneys of deceased donors. Weighted Cohen's kappa was used for inter‐rater agreement. Mean (SD) donor age was 50 (13). Acute tubular injury had kappas of 0.12, 0.14, and 0.19; arteriolar hyalinosis 0.16, 0.27, and 0.38; interstitial inflammation 0.30, 0.33, and 0.49; interstitial fibrosis 0.28, 0.32, and 0.67; arterial intimal fibrosis 0.34, 0.42, and 0.59; tubular atrophy 0.35, 0.41, and 0.52; glomeruli thrombi 0.32, 0.53, and 0.85; and global glomerulosclerosis 0.68, 0.70, and 0.77. Pathologists’ agreement demonstrated kappas of 0.12 to 0.77. The lower values raise concern about the reliability of using images. Although further research is needed to understand how uploaded images are used clinically, the field may consider higher‐quality standards for biopsy photomicrographs.