The placement of kidneys from deceased organ donors of advanced age is an ongoing challenge. An Organ Procurement Organization (OPO) evaluated its discard rate for older kidneys that met previously-established post-procurement needle biopsy criteria. It was postulated that the criteria being used to qualify donors for biopsy may result in unnecessarily biopsying kidneys from many donors over 50 yrs, perhaps leading to higher discard rates.

Purpose: To implement new kidney biopsy criteria in our large OPO and to study the effect of this change on donors over age 50 yrs. The new biopsy criteria were: any donor with a kidney donor profile index [KDPI] of ≥ 85.

Methods: All donors over age 50 yrs were examined to evaluate the impact of the updated biopsy criteria. This resulted in two donor data sets: (1) Those over 50 yrs using the previously-established biopsy criteria of: age ≥ 50 yrs, donation after circulatory death, past medical history of diabetes with a duration > 12 yrs, or disseminated intravascular coagulopathy. Donors were retrospectively analyzed from Jan to Nov 2016 (n=53). (2) The comparison group (new criteria) were donors over 50 yrs, but with KDPI ≥ 85 (n=38). Donor data were prospectively collected on this group from Dec 2016 through June 2017. In both donor populations, biopsies were also performed as requested by either the OPO medical director or accepting transplant center.

Results: After the change in biopsy criteria was implemented, there was a 65.8% reduction in the number of kidney biopsies obtained from donors over age 50 yrs. The reduction of biopsies in this population is advantageous for both the OPO and transplant center as obtaining, transporting, and processing of the biopsy was found to add an average of 9.5 hrs of cold ischemic time. Despite the reduction in biopsies, however, we realized a 4.5% decrease in kidney discards. The annualized impact for this could lead to a reduction of approximately 120 biopsies and an increase in 7 kidneys transplanted from this OPO.

Conclusion: By implementing a much more restrictive criteria for performing biopsies in elderly deceased kidney donors (KDPI ≥ 85), this OPO significantly decreased the number of biopsies performed while, AT THE SAME TIME, witnessing a reduction in the number of kidney discards.

CITATION INFORMATION: Hostetler C., Rogge J., Nicely B., Rudich S. Reducing Discards for Deceased Kidney Donors over Age 50 by Restricting Biopsy Criteria Am J Transplant. 2017;17 (suppl 3).

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