Assessment of the Utility of Kidney Histology as a Basis for Discarding Organs in the United States: A Comparison of International Transplant Practices and Outcomes.
Reese, Peter P.; Aubert, Olivier; Naesens, Maartenet al.
2021 • In Journal of the American Society of Nephrology : JASN, 32 (2), p. 397-409
Adult; Aged; Allografts/pathology; Europe; Female; Graft Survival; Humans; Kidney/pathology; Kidney Transplantation; Male; Middle Aged; Practice Patterns, Physicians'; Predictive Value of Tests; Proportional Hazards Models; Time Factors; Tissue and Organ Procurement/organization & administration; United States; epidemiology and outcomes; kidney biopsy; pathology; transplant outcomes
Abstract :
[en] BACKGROUND: Many kidneys donated for transplant in the United States are discarded because of abnormal histology. Whether histology adds incremental value beyond usual donor attributes in assessing allograft quality is unknown. METHODS: This population-based study included patients who received a deceased donor kidney that had been biopsied before implantation according to a prespecified protocol in France and Belgium, where preimplantation biopsy findings are generally not used for decision making in the allocation process. We also studied kidneys that had been acquired from deceased United States donors for transplantation that were biopsied during allocation and discarded because of low organ quality. Using donor and recipient characteristics, we fit multivariable Cox models for death-censored graft failure and examined whether predictive accuracy (C index) improved after adding donor histology. We matched the discarded United States kidneys to similar kidneys transplanted in Europe and calculated predicted allograft survival. RESULTS: In the development cohort of 1629 kidney recipients at two French centers, adding donor histology to the model did not significantly improve prediction of long-term allograft failure. Analyses using an external validation cohort from two Belgian centers confirmed the lack of improved accuracy from adding histology. About 45% of 1103 United States kidneys discarded because of histologic findings could be accurately matched to very similar kidneys that had been transplanted in France; these discarded kidneys would be expected to have allograft survival of 93.1% at 1 year, 80.7% at 5 years, and 68.9% at 10 years. CONCLUSIONS: In this multicenter study, donor kidney histology assessment during allocation did not provide substantial incremental value in ascertaining organ quality. Many kidneys discarded on the basis of biopsy findings would likely benefit United States patients who are wait listed.
Assessment of the Utility of Kidney Histology as a Basis for Discarding Organs in the United States: A Comparison of International Transplant Practices and Outcomes.
Publication date :
2021
Journal title :
Journal of the American Society of Nephrology : JASN
Organ Procurement and Transplantation Network: National Data: Overall by Organ. Available at: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#. Accessed December 6, 2019
Cooper M, Formica R, Friedewald J, Hirose R, O’Connor K, Mohan S, et al.: Report of National Kidney Foundation Consensus Conference to decrease kidney discards. Clin Transplant 33: e13419, 2019
Reese PP, Harhay MN, Abt PL, Levine MH, Halpern SD: New solutions to reduce discard of kidneys donated for transplantation. J Am Soc Nephrol 27: 973–980, 2016
Mohan S, Chiles MC, Patzer RE, Pastan SO, Husain SA, Carpenter DJ, et al.: Factors leading to the discard of deceased donor kidneys in the United States. Kidney Int 94: 187–198, 2018
Trump DJ: Executive order on Advancing American Kidney Health, 2019. Available at: https://www.whitehouse.gov/presidential-actions/executive-order-advancing-american-kidney-health/. Accessed October 29, 2020
Kasiske BL, Stewart DE, Bista BR, Salkowski N, Snyder JJ, Israni AK, et al.: The role of procurement biopsies in acceptance decisions for kidneys retrieved for transplant. Clin J Am Soc Nephrol 9: 562–571, 2014
Aubert O, Reese PP, Audry B, Bouatou Y, Raynaud M, Viglietti D, et al.: Disparities in acceptance of deceased donor kidneys between the United States and France and estimated effects of increased US acceptance. JAMA Intern Med 179: 1365–1374, 2019
Massie AB, Luo X, Chow EK, Alejo JL, Desai NM, Segev DL: Survival benefit of primary deceased donor transplantation with high-KDPI kidneys. Am J Transplant 14: 2310–2316, 2014
Carpenter D, Husain SA, Brennan C, Batal I, Hall IE, Santoriello D, et al.: Procurement biopsies in the evaluation of deceased donor kidneys. Clin J Am Soc Nephrol 13: 1876–1885, 2018
Lentine KL, Naik AS, Schnitzler MA, Randall H, Wellen JR, Kasiske BL, et al.: Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation. Am J Transplant 19: 2241–2251, 2019
Cockfield SM, Moore RB, Todd G, Solez K, Gourishankar S: The prognostic utility of deceased donor implantation biopsy in determining function and graft survival after kidney transplantation. Transplantation 89: 559–566, 2010
Remuzzi G, Grinyò J, Ruggenenti P, Beatini M, Cole EH, Milford EL, et al.; Double Kidney Transplant Group (DKG): Early experience with dual kidney transplantation in adults using expanded donor criteria. J Am Soc Nephrol 10: 2591–2598, 1999
Munivenkatappa RB, Schweitzer EJ, Papadimitriou JC, Drachenberg CB, Thom KA, Perencevich EN, et al.: The Maryland aggregate pathology index: A deceased donor kidney biopsy scoring system for predicting graft failure. Am J Transplant 8: 2316–2324, 2008
De Vusser K, Lerut E, Kuypers D, Vanrenterghem Y, Jochmans I, Monbaliu D, et al.: The predictive value of kidney allograft baseline biopsies for long-term graft survival. J Am Soc Nephrol 24: 1913–1923, 2013
Wang CJ, Wetmore JB, Crary GS, Kasiske BL: The donor kidney biopsy and its implications in predicting graft outcomes: A systematic review. Am J Transplant 15: 1903–1914, 2015
Maenosono R, Tullius SG: Saving lives by saving kidneys for transplant [published online ahead of print August 26, 2019]. JAMA Intern Med10.1001/jamainternmed.2019.2609
Organ Procurement and Transplantation Network (OPTN). Available at: https://optn.transplant.hrsa.gov/data/about-data/. Accessed October 29, 2020
Haas M, Sis B, Racusen LC, Solez K, Glotz D, Colvin RB, et al.; Banff meeting report writing committee: Banff 2013 meeting report: Inclusion of c4d-negative antibody-mediated rejection and antibody-associated arterial lesions [published correction appears in Am J Transplant 15: 2784, 2015 10.1111/ajt.13517]. Am J Transplant 14: 272–283, 2014
Rao PS, Schaubel DE, Guidinger MK, Andreoni KA, Wolfe RA, Merion RM, et al.: A comprehensive risk quantification score for deceased donor kidneys: The kidney donor risk index. Transplantation 88: 231–236, 2009
Lamb KE, Lodhi S, Meier-Kriesche HU: Long-term renal allograft survival in the United States: A critical reappraisal. Am J Transplant 11: 450–462, 2011
Efron B: Bootstrap methods: Another look at the jackknife. Ann Stat 7: 1–26, 1979
Rosenbaum PR: Optimal matching for observational studies. J Am Stat Assoc 84: 1024–1032, 1989
Austin PC: Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 10: 150–161, 2011
Zubizarreta J: Using mixed integer programming for matching in an observational study of kidney failure after surgery. J Am Stat Assoc 107: 1360–1371, 2012
Austin PC: Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28: 3083–3107, 2009
de Los Angeles Resa M, Zubizarreta JR: Evaluation of subset matching methods and forms of covariate balance. Stat Med 35: 4961–4979, 2016
Zubizarreta J, Kilcioglu C, Vielma J: Package ‘designmatch’: Matched samples that are balanced and representative by design, 2018. Available at: https://cran.r-project.org/web/packages/designmatch/designmatch.pdf. Accessed October 26, 2019
Greifer N: Cobalt: Covariate balance tables and plots, 2019. Available at: https://cran.r-project.org/web/packages/cobalt/index.html. Accessed October 26, 2019
Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al.: Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341: 1725–1730, 1999
Stewart DE, Garcia VC, Rosendale JD, Klassen DK, Carrico BJ: Diagnosing the decades-long rise in the deceased donor kidney discard rate in the United States. Transplantation 101: 575–587, 2017
Marrero WJ, Naik AS, Friedewald JJ, Xu Y, Hutton DW, Lavieri MS, et al.: Predictors of deceased donor kidney discard in the United States. Transplantation 101: 1690–1697, 2017
Muruve NA, Steinbecker KM, Luger AM: Are wedge biopsies of cadaveric kidneys obtained at procurement reliable? Transplantation 69: 2384–2388, 2000
Schold J, Srinivas TR, Sehgal AR, Meier-Kriesche HU: Half of kidney transplant candidates who are older than 60 years now placed on the waiting list will die before receiving a deceased-donor transplant. Clin J Am Soc Nephrol 4: 1239–1245, 2009
Merion RM, Ashby VB, Wolfe RA, Distant DA, Hulbert-Shearon TE, Metzger RA, et al.: Deceased-donor characteristics and the survival benefit of kidney transplantation. JAMA 294: 2726–2733, 2005
Cohen JB, Potluri V, Porrett PM, Chen R, Roselli M, Shults J, et al.: Leveraging marginal structural modeling with Cox regression to assess the survival benefit of accepting vs declining kidney allograft offers. Am J Transplant 19: 1999–2008, 2019
Bae S, Massie AB, Thomas AG, Bahn G, Luo X, Jackson KR, et al.: Who can tolerate a marginal kidney? Predicting survival after deceased donor kidney transplant by donor-recipient combination. Am J Transplant 19: 425–433, 2019
Kadatz M, Gill JS: Compelling evidence of the need for policy change to decrease deceased donor kidney discard in the United States: Waste not want less. Clin J Am Soc Nephrol 13: 13–15, 2018
Moeckli B, Sun P, Lazeyras F, Morel P, Moll S, Pascual M, et al.: Evaluation of donor kidneys prior to transplantation: An update of current and emerging methods. Transpl Int 32: 459–469, 2019
Azancot MA, Moreso F, Salcedo M, Cantarell C, Perello M, Torres IB, et al.: The reproducibility and predictive value on outcome of renal biopsies from expanded criteria donors. Kidney Int 85: 1161–1168, 2014
Pokorná E, Vítko S, Chadimová M, Schück O, Ekberg H: Proportion of glomerulosclerosis in procurement wedge renal biopsy cannot alone discriminate for acceptance of marginal donors. Transplantation 69: 36–43, 2000
Wang JH, Skeans MA, Israni AK: Current status of kidney transplant outcomes: Dying to survive. Adv Chronic Kidney Dis 23: 281–286, 2016
Merion RM, Goodrich NP, Johnson RJ, McDonald SP, Russ GR, Gillespie BW, et al.: Kidney transplant graft outcomes in 379 257 recipients on 3 continents. Am J Transplant 18: 1914–1923, 2018
Ayorinde JO, Summers DM, Pankhurst L, Laing E, Deary AJ, Hemming K, et al.: PreImplantation Trial of Histopathology In renal Allografts (PITHIA): A stepped-wedge cluster randomised controlled trial protocol. BMJ Open 9: e026166, 2019
Ibrahim M, Vece G, Mehew J, Johnson R, Forsythe J, Klassen D, et al.: An international comparison of deceased donor kidney utilization: What can the United States and the United Kingdom learn from each other? Am J Transplant 20: 1309–1322, 2020
