*Purpose:

Procurement biopsies (PBx) are commonly used to evaluate the quality of deceased donor kidneys (DDK). However, the validity of PBx biopsy interpretation has been questioned, as PBx often show discordant quality compared to gold standard post-transplant reperfusion biopsies (RBx). One potential reason is that wedge PBx over-represent scarred subcapsular tissue, leading to artifactual decrease in PBx quality score compared to RBx which are often needle core biopsies. Therefore, we sought to determine whether PBx technique (core versus wedge) influenced the agreement between PBx and RBx.

*Methods: We analyzed 458 consecutive DDK used as single organ transplants at our center from 2006-2016 with known PBx technique and available RBx. Glomerulosclerosis (GS), interstitial fibrosis/tubular atrophy (IFTA), and vascular disease (VD) were obtained from biopsy reports. We defined suboptimal histology on PBx and RBx as GS≥11%, or at least moderate IFTA or VD. Concordance of optimal classification was assessed.

*Results: Of 458 DDK included, PBx was performed by needle core biopsy in 251 (55%), with the majority of core PBX (214, 85%) performed at a single OPO. PBx showed optimal histology in 296 DDK (64%), and 277 (60%) showed optimal histology on RBx. Concordant histology between PBx and RBx was seen in 295 cases (64%, kappa 0.24) (Fig 1). Concordance between RBx and either needle core PBx (66%, kappa = 0.23) or wedge PBx (62%, kappa 0.25) PBx were similar (p=0.40). We then examined GS as a continuous variable, and also found no significant difference between core versus wedge PBx in terms of correlation RBx, with poor correlation regardless of PBx biopsy technique (wedge r² = 0.09, core r² = 0.14) (fig 2)

*Conclusions: Poor correlation between PBx and RBx was confirmed. The differences in histologic scores between PBx and RBx do not appear to be related to PBx biopsy technique, and alternative causes such as processing quality and pathologist experience should be analyzed.

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