The reproducibility and predictive value on outcome of renal biopsies from expanded criteria donors

M. Antonieta Azancot, Francesc Moreso, Maite Salcedo, Carme Cantarell, Manel Perello, Irina B. Torres, Angeles Montero, Enric Trilla, Joana Sellarés, Joan Morote, Daniel Seron

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76 Citations (Scopus)

Abstract

Reproducibility and predictive value on outcome are the main criteria to evaluate the utility of histological scores. Here we analyze the reproducibility of donor biopsy assessment by different on-call pathologists and the retrospective evaluation by a single renal pathologist blinded to clinical outcomes. We also evaluate the predictive value on graft outcome of both evaluations. A biopsy was performed in donors with any of the following: age ≥55 years, hypertension, diabetes, creatinine >1.5 mg/dl, or stroke. Glomerulosclerosis, interstitial fibrosis, tubular atrophy, intimal thickening, and arteriolar hyalinosis evaluated according to the Banff criteria were added to obtain a chronic score. Biopsies were classified as mild (≥3), intermediate (4-5), or advanced (6-7) damage, and unacceptable (≥8) for transplantation of 127 kidneys biopsied. Weighted κ value between both readings was 0.41 (95% CI: 0.28-0.54). Evaluation of biopsies by the renal pathologist was significantly and independently associated with estimated 12-month glomerular filtration rate and a significant composite outcome variable, including death-censored graft survival and time to reach an estimated glomerular filtration rate <30 ml/min per 1.73 m 2. Thus, there was no association between readings of on-call pathologists and outcome. The lack of association between histological scores obtained by the on-call pathologists and graft outcome suggests that a specific training on renal pathology is recommended to optimize the use of kidneys retrieved from expanded criteria donors. © 2014 International Society of Nephrology.
Original languageEnglish
Pages (from-to)1161-1168
JournalKidney International
Volume85
Issue number5
DOIs
Publication statusPublished - 1 Jan 2014

Keywords

  • Donor pre-implantation biopsies
  • Expanded criteria donors
  • Kidney transplantation

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