Glomerulosclerosis Patterns Are Non-Uniform Throughout the KDPI Spectrum With Impact on Biopsy Evaluation of Kidneys for Transplant

M. Jendrisak,¹ K. Mulawa,¹ M. Harmon,¹ D. Cimbaluk.²

¹Gift of Hope Organ & Tissue Donor Network, Itasca, IL
²Rush University, Chicago, IL.

Meeting: 2015 American Transplant Congress

Abstract number: B302

Keywords: Biopsy, Cadaveric organs, Donors, Kidney, marginal

Background: The kidney donor profile index (KDPI) stratifies kidney quality with direct bearing on organ allocation and utilization. Procurement biopsy is commonly performed and factored into the assessment of organ quality in donors with high KDPI despite absent validation.

Methods: Retrospective analysis of 705 procurement renal biopsies from 1503 kidneys recovered from 365 donors in this donor service area between 2011 through 2013 was performed for correlation with KDPI, utilization and outcome. Nine wedge biopsies taken from each of 17 non-transplanted kidneys with KDPI ranging from 40 to 100 were examined for histologic consistency. Kidney utilization and transplant outcome data was obtained from internal and UNOS databases.

Results: As shown in

Procurement Biopsy Findings and Utilization

KDPI	0-20	21-55	56-85	86-100
Recovered Kidneys	39	171	312	175
GS < 20%	95%	95%	81%	65%
GS < 10%	95%	83%	61%	44%
Transplanted Kidneys	32(82%)	143 (84%)	209 (67%)	71 (41%)
GS < 20%	100%	97%	95%	92%
GS < 10%	100%	88%	76%	75%
1 Year Survival
Patient	69%	78%	73%	70%
Graft	69%	78%	71%	68%

, the percent glomerulosclerosis (%GS) below 10% and 20% in donor kidneys declined with advancing KDPI with parallel decline in utilization. In the highest KDPI group, 65% of kidney had 20% GS or less but only 41% utilization. One year patient and graft survival was nearly identical among all groups.

Non-uniformity of Glomerulosclerosis Patterns Throughout the KDPI Spectrum

Kidneys		% Glomerulosclerosis
KDPI	N	Mean	SD	High	Low
40	1	3	2	8	1
62	1	5	2	9	3
75	5	17	12	49	1
80	1	18	4	25	11
90	2	26	7	45	15
98	1	33	6	40	25
100	6	28	19	77	3

summarizes the increased variability in %GS found in multiple biopsies of non-transplanted kidneys as KDPI ranged from 40 to 100.

Conclusion: Glomerulosclerosis is not uniform throughout kidneys which could lead to error in organ quality assessment. Outcome data suggests significant underutilization with aggressive biopsy practice.

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