Featured Research

from universities, journals, and other organizations

Biopsies before transplantation do not determine success of donated kidneys

Date:
February 20, 2014
Source:
American Society of Nephrology (ASN)
Summary:
Biopsy-detected injury in donated kidneys was modestly associated with a delay in organ function in the first week after transplantation, but only for donor kidneys already known to be at high risk. Donor kidney biopsies frequently underreported kidney injury with substantial variability. The study also showed that there was a large degree of overlap between the results of biopsies from kidneys that were deemed unsuitable for transplantation and kidneys that were approved for transplantation. The quality of biopsies used in acceptance decisions was low.

Biopsies of donated kidneys provide little information for determining the suitability of organs for transplantation, according to two studies appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings suggest that other methods are needed when weighing whether to discard or transplant a deceased donor kidney.

The quality of donated kidneys is fundamentally important for the longevity of kidney transplants. Clinicians often use kidney biopsies to assess kidney health before transplantation. Chirag Parikh, MD, PhD and Isaac Hall, MD, MS (Yale University and Veterans Affairs Medical Center) led a team that looked for associations between biopsy-reported kidney injury at the time of organ procurement with subsequent kidney transplant outcomes. "We were hoping to expand our knowledge about these associations and explain inconsistent findings in the medical literature by performing the largest multicenter study of its kind to date," said Dr. Hall.

Between March 2010 and April 2012, the researchers biopsied 651 kidneys (taken from 369 donors through four organ procurement organizations) that were subsequently transplanted into recipients. The team found that biopsy-reported kidney injury was modestly associated with a delay in organ function in the first week after transplantation, but only for a subgroup of donor kidneys already known to be at high risk for this early outcome. The investigators also found that donor kidney biopsies frequently underreported acute kidney injury with substantial variability.

"Biopsies are listed as the primary reasons for discarding deceased-donor kidneys; however, as they currently relate to reported acute kidney injury, they provide little utility for determining the overall risk of delayed organ function or even premature organ failure," said Dr. Parikh.

In another study, Bertram Kasiske, MD (Scientific Registry of Transplant Recipients and Hennepin County Medical Center) and his colleagues compared the results of biopsies from kidneys that were discarded with the results of biopsies from comparable kidneys that were successfully transplanted. In particular, the researchers compared biopsies of both kidneys from the same donor, when one kidney was transplanted and the other was discarded. The analysis included biopsy reports from 83 kidneys discarded due to biopsy findings, 83 contralateral transplanted kidneys from the same donor, and 83 deceased donors randomly matched to cases by donor risk profile.

The team found that there was a large degree of overlap between the results of biopsies from kidneys that were discarded and kidneys that were transplanted. The researchers also found that the quality of the biopsies used in acceptance decisions was low. The percentage of glomeruli (the filtering units of the kidney) that were scarred was most often used to decide whether kidneys were discarded or transplanted; however, this value was highly variable, even in biopsies from the same kidney.

Graft survival at one year was 80% for kidneys contralateral to discarded kidneys. This compares with one-year graft survival of 92% among all deceased donor kidney transplants in the Scientific Registry of Transplant Recipients. "If the discarded kidneys had been transplanted with the same graft survival as the transplanted kidneys from the opposite side, many patients may have benefited," said Dr. Kasiske. "Altogether these results question whether routine procurement biopsies result in discarding kidneys that could be acceptable for many of the patients who die waiting for a kidney transplant," he added.

In an editorial accompanying Dr. Kasiske's article, Sayeed Khan Malek, MD (Brigham and Women's Hospital) wrote, "When the biopsy findings are consistent with the clinical evaluation of the donor, they are useful in making the determination about transplanting the kidney. However, biopsy findings when considered in isolation are of limited value and should be interpreted with caution when making the decision to turn down a potentially transplantable kidney."


Story Source:

The above story is based on materials provided by American Society of Nephrology (ASN). Note: Materials may be edited for content and length.


Journal References:

  1. S. K. Malek. Procurement Biopsies in Kidneys Retrieved for Transplantation. Clinical Journal of the American Society of Nephrology, 2014; DOI: 10.2215/CJN.00470114
  2. B. L. Kasiske, D. E. Stewart, B. R. Bista, N. Salkowski, J. J. Snyder, A. K. Israni, G. S. Crary, J. D. Rosendale, A. J. Matas, F. L. Delmonico. The Role of Procurement Biopsies in Acceptance Decisions for Kidneys Retrieved for Transplant. Clinical Journal of the American Society of Nephrology, 2014; DOI: 10.2215/CJN.07610713

Cite This Page:

American Society of Nephrology (ASN). "Biopsies before transplantation do not determine success of donated kidneys." ScienceDaily. ScienceDaily, 20 February 2014. <www.sciencedaily.com/releases/2014/02/140220193331.htm>.
American Society of Nephrology (ASN). (2014, February 20). Biopsies before transplantation do not determine success of donated kidneys. ScienceDaily. Retrieved September 22, 2014 from www.sciencedaily.com/releases/2014/02/140220193331.htm
American Society of Nephrology (ASN). "Biopsies before transplantation do not determine success of donated kidneys." ScienceDaily. www.sciencedaily.com/releases/2014/02/140220193331.htm (accessed September 22, 2014).

Share This



More Health & Medicine News

Monday, September 22, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Sierra Leone in Lockdown to Control Ebola

Sierra Leone in Lockdown to Control Ebola

AP (Sep. 21, 2014) Sierra Leone residents remained in lockdown on Saturday as part of a massive effort to confine millions of people to their homes in a bid to stem the biggest Ebola outbreak in history. (Sept. 20) Video provided by AP
Powered by NewsLook.com
Sierra Leone's Nationwide Ebola Curfew Underway

Sierra Leone's Nationwide Ebola Curfew Underway

Newsy (Sep. 20, 2014) Sierra Leone is locked down as aid workers and volunteers look for new cases of Ebola. Video provided by Newsy
Powered by NewsLook.com
Changes Found In Brain After One Dose Of Antidepressants

Changes Found In Brain After One Dose Of Antidepressants

Newsy (Sep. 19, 2014) A study suggest antidepressants can kick in much sooner than previously thought. Video provided by Newsy
Powered by NewsLook.com
Could Grief Affect The Immune Systems Of Senior Citizens?

Could Grief Affect The Immune Systems Of Senior Citizens?

Newsy (Sep. 19, 2014) The study found elderly people are much more likely to become susceptible to infection than younger adults going though a similar situation. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins