*Purpose: Pathologic assessment of donor organs by use of procurement biopsies (PB) provides information regarding organ quality. Most commonly cited reason for organ discard is PB results. However, evaluation is limited by freezing artifact and inability to perform ancillary studies including special stains, immunofluorescence (IF) and electron microscopy (EM). To better understand donor kidney status our institute performs paraffin embedded reperfusion biopsies (Time Zero biopsy- T0B).

*Methods: A retrospective review of 65 T0B was performed from 2017 to 2018. Thirty-three (51%) of these donor kidneys had PB information available as well. PB and T0B were compared for number of glomeruli, interstitial fibrosis with tubular atrophy, glomerulosclerosis and vascular changes. Biopsy results were compared with post-transplant disease diagnoses, serum creatinine and graft survival.

*Results: Twenty-five (38%) T0B established new diagnoses including ATN (60%), donor-IgA (20%), donor-lupus nephritis (8%), hemosiderosis (8%) and DIC (4%). Nineteen (29%) recipients underwent post-transplant indication biopsies (1 day to 13 months), 47% had donor related glomerular disease, 5% had de novo glomerular disease and 5% could not be compared due to insufficient T0B material. The average number of sampled glomeruli was 52 and 14 in PB and T0B, respectively. Histological features of the PB were not reliably reproducible in 78% of T0B. No significant association was found in the PB and T0B Two tailed P=0.554. In these 78% cases where histologic features were not reproducible, 60% had mean serum creatinine 1.78±0.73 mg/dl. Among the patients whose PB and T0B features correlated, 37% had mean serum creatinine 1.43±0.42 mg/dl. There was no significant difference in the serum creatinine between both groups P= 0.221. Graft survival at last follow up was comparable.

*Conclusions: Procurement biopsy results may not be reproducible at re-perfusion biopsy, and may not significantly correlate with clinical outcomes. Reperfusion biopsies provide more information on the donor kidneys and subsequent development of donor related issues. It may be suggested that yield of PB can be improved by allocating a portion of the PB material in formalin for permanent sections, IF and EM, which would allow the benefits of both PB and T0B in one procedure.

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