Organ-Procurement Organization and Donor Factor-Related Variation in Deceased Donor Kidney Biopsies and Discards: A National Practice Patterns Analysis

K. Lentine¹, A. Naik², M. Schnitzler¹, H. Randall¹, J. Wellen³, B. Kasiske⁴, G. Marklin⁵, D. Brockmeier⁵, M. Cooper⁶, H. Xiao¹, Z. Zhang¹, R. Gaston⁶, R. Rothweiler⁵, D. Axelrod⁷

¹Saint Louis Univ, St. Louis, MO, ²Univ of Michigan, Ann Arbor, MI, ³Washington Univ, St. Louis, MO, ⁴SRTR, Minneapolis, MN, ⁵Mid-America Transplant, St. Louis, MO, ⁶Georgetown Univ, Washington, DC, ⁷Univ of Iowa, Iowa City, IA

Meeting: 2019 American Transplant Congress

Abstract number: B140

Keywords: Biopsy, Kidney transplantation, Multivariate analysis, Procurement

Session Information

Session Name: Poster Session B: Kidney Donor Selection / Management Issues

Session Type: Poster Session

Date: Sunday, June 2, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: The clinical utility and outcome implications of deceased donor kidney allograft procurement biopsies are controversial.

*Methods: We analyzed Scientific Registry of Transplant Recipients data (n=59,328 allografts, 201418) to describe biopsy practices across US organ procurement organizations (OPOs), and examine relationships with discards, using hierarchical modeling to account for OPO and donor factors. Median odds ratios (MOR) provided medians of the odds that allografts with identical reported traits would be biopsied or discarded from 2 randomly drawn OPOs.

*Results: Average biopsy rate was 52.7%, range 22.8%-77.5% across OPOs (Fig A); average discard rate was 18.4%, range 6.6% 32.1%. Biopsy rose in a graded manner with kidney donor profile index (KDPI) (Fig B), but practice varied across OPOs after adjusting for KDPI and other donor factors. Biopsy was associated with discard, most pronounced among low-risk (KDPI <20) kidneys (adjusted odds ratio (_95%LCLaOR _95%UCL)_5.456.47_7.69), with minimal impact at KDPI >85 (Fig C). After adjusting for OPO, likelihood of discard rose in a graded manner with higher KDPI (>85: aOR _10.3111.18_12.12) and PHS Increased risk/hepatitis C seropositivity KDPI (>85: aOR _4.084.53_5.03). Variation in discards differed by biopsy status, with less variability for biopsied vs non-biopsied kidneys at KDPIs >20 (MOR: KDPI 20-50: 1.38 vs 1.46; KDPI 51-85: 1.40 vs 1.65; KDPI >85: 1.74 vs 1.98) (Fig D). At low KDPI, discards varied more when a biopsy was done.

*Conclusions: Kidney allograft procurement biopsy and discard practices varied considerably across OPOs. Biopsy correlated with discards; the relationship was complex and strongest for low-risk organs. More evidence is needed to inform standards for biopsy performance, and use and application of biopsy results.

To cite this abstract in AMA style:

Lentine K, Naik A, Schnitzler M, Randall H, Wellen J, Kasiske B, Marklin G, Brockmeier D, Cooper M, Xiao H, Zhang Z, Gaston R, Rothweiler R, Axelrod D. Organ-Procurement Organization and Donor Factor-Related Variation in Deceased Donor Kidney Biopsies and Discards: A National Practice Patterns Analysis [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/organ-procurement-organization-and-donor-factor-related-variation-in-deceased-donor-kidney-biopsies-and-discards-a-national-practice-patterns-analysis/. Accessed November 22, 2024.

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