Postreperfusion Renal Allograft Biopsy Predicts Outcome of Single-Kidney Transplantation: A 10-Year Observational Study in China
Introduction: Biopsy findings often lead to the discard of many donor kidneys although their clinical value is not fully understood. We investigated the predictive value of postreperfusion biopsy on long-term allograft outcome after single-kidney transplantation. Methods: We retrospectively evaluate...
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Elsevier
2024-01-01
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| Series: | Kidney International Reports |
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| author | Meifang Wang Junhao Lv Jie Zhao Huiping Wang Jianghua Chen Jianyong Wu |
| author_facet | Meifang Wang Junhao Lv Jie Zhao Huiping Wang Jianghua Chen Jianyong Wu |
| author_sort | Meifang Wang |
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| description | Introduction: Biopsy findings often lead to the discard of many donor kidneys although their clinical value is not fully understood. We investigated the predictive value of postreperfusion biopsy on long-term allograft outcome after single-kidney transplantation. Methods: We retrospectively evaluated the significance of histologic findings, read by experienced renal pathologists, in 461 postreperfusion biopsy specimens collected from 2010 to 2017 after deceased donor renal transplant; and performed time-to-event analyses to determine the association between histology and hazard of death-censored graft failure. Recipients were followed-up with over a median time of 6.8 (range, 0.2–11.9) years. We assessed specimens using the Remuzzi score (scale of 0–12) and categorized them into low-score (≤3) and high-score (>3) groups. Kappa coefficients were calculated to assess agreement in procurement versus reperfusion biopsies. Results: High Remuzzi score kidneys came from older donors with a higher incidence of hypertension, higher final creatinine, death from cerebrovascular disease, expanded criteria donor, and a higher kidney donor risk index (KDRI) (all P < 0.001). In adjusted analyses, Remuzzi score was independently associated with death-censored graft failure (hazard ratio [HR] 1.389 for each 1 score rise in Remuzzi score, 95% confidence interval 1.181–1.633, P < 0.001). Overall histologic agreement (procurement biopsy versus reperfusion biopsy) was kappa = 0.137. Conclusion: Our findings suggest that postreperfusion biopsy is associated with long-time graft outcomes after transplant from a deceased donor. Agreement between procurement and reperfusion biopsy was found to be low. Prospective trials are necessary to optimize procurement biopsy practices. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2024-01-01 |
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| series | Kidney International Reports |
| spelling | doaj-art-8e69660ed87149dbb26d16bdafec5eb92025-08-20T03:45:06ZengElsevierKidney International Reports2468-02492024-01-01919610710.1016/j.ekir.2023.10.021Postreperfusion Renal Allograft Biopsy Predicts Outcome of Single-Kidney Transplantation: A 10-Year Observational Study in ChinaMeifang Wang0Junhao Lv1Jie Zhao2Huiping Wang3Jianghua Chen4Jianyong Wu5Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China; National Key Clinical Department of Kidney Diseases, Hangzhou, China; Institute of Nephrology, Zhejiang University, Hangzhou, China; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, ChinaKidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China; National Key Clinical Department of Kidney Diseases, Hangzhou, China; Institute of Nephrology, Zhejiang University, Hangzhou, China; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, ChinaKidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China; National Key Clinical Department of Kidney Diseases, Hangzhou, China; Institute of Nephrology, Zhejiang University, Hangzhou, China; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, ChinaKidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China; National Key Clinical Department of Kidney Diseases, Hangzhou, China; Institute of Nephrology, Zhejiang University, Hangzhou, China; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, ChinaKidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China; National Key Clinical Department of Kidney Diseases, Hangzhou, China; Institute of Nephrology, Zhejiang University, Hangzhou, China; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, ChinaKidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China; National Key Clinical Department of Kidney Diseases, Hangzhou, China; Institute of Nephrology, Zhejiang University, Hangzhou, China; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China; Correspondence: Jianyong Wu, Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, China.Introduction: Biopsy findings often lead to the discard of many donor kidneys although their clinical value is not fully understood. We investigated the predictive value of postreperfusion biopsy on long-term allograft outcome after single-kidney transplantation. Methods: We retrospectively evaluated the significance of histologic findings, read by experienced renal pathologists, in 461 postreperfusion biopsy specimens collected from 2010 to 2017 after deceased donor renal transplant; and performed time-to-event analyses to determine the association between histology and hazard of death-censored graft failure. Recipients were followed-up with over a median time of 6.8 (range, 0.2–11.9) years. We assessed specimens using the Remuzzi score (scale of 0–12) and categorized them into low-score (≤3) and high-score (>3) groups. Kappa coefficients were calculated to assess agreement in procurement versus reperfusion biopsies. Results: High Remuzzi score kidneys came from older donors with a higher incidence of hypertension, higher final creatinine, death from cerebrovascular disease, expanded criteria donor, and a higher kidney donor risk index (KDRI) (all P < 0.001). In adjusted analyses, Remuzzi score was independently associated with death-censored graft failure (hazard ratio [HR] 1.389 for each 1 score rise in Remuzzi score, 95% confidence interval 1.181–1.633, P < 0.001). Overall histologic agreement (procurement biopsy versus reperfusion biopsy) was kappa = 0.137. Conclusion: Our findings suggest that postreperfusion biopsy is associated with long-time graft outcomes after transplant from a deceased donor. Agreement between procurement and reperfusion biopsy was found to be low. Prospective trials are necessary to optimize procurement biopsy practices.http://www.sciencedirect.com/science/article/pii/S2468024923015619kidney transplant outcomesorgan utilizationpostreperfusion biopsyprocurement biopsyreproducibility of resultstransplant pathology |
| spellingShingle | Meifang Wang Junhao Lv Jie Zhao Huiping Wang Jianghua Chen Jianyong Wu Postreperfusion Renal Allograft Biopsy Predicts Outcome of Single-Kidney Transplantation: A 10-Year Observational Study in China Kidney International Reports kidney transplant outcomes organ utilization postreperfusion biopsy procurement biopsy reproducibility of results transplant pathology |
| title | Postreperfusion Renal Allograft Biopsy Predicts Outcome of Single-Kidney Transplantation: A 10-Year Observational Study in China |
| title_full | Postreperfusion Renal Allograft Biopsy Predicts Outcome of Single-Kidney Transplantation: A 10-Year Observational Study in China |
| title_fullStr | Postreperfusion Renal Allograft Biopsy Predicts Outcome of Single-Kidney Transplantation: A 10-Year Observational Study in China |
| title_full_unstemmed | Postreperfusion Renal Allograft Biopsy Predicts Outcome of Single-Kidney Transplantation: A 10-Year Observational Study in China |
| title_short | Postreperfusion Renal Allograft Biopsy Predicts Outcome of Single-Kidney Transplantation: A 10-Year Observational Study in China |
| title_sort | postreperfusion renal allograft biopsy predicts outcome of single kidney transplantation a 10 year observational study in china |
| topic | kidney transplant outcomes organ utilization postreperfusion biopsy procurement biopsy reproducibility of results transplant pathology |
| url | http://www.sciencedirect.com/science/article/pii/S2468024923015619 |
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