The added benefits of zero-time biopsy of a potential donor kidney on top of standard donor biological and clinical data to aid in the decision to accept or discard the organ remain unclear. However, following the introduction of the Kidney Donor Profile Index, zero-time biopsy data remain the main reason that kidneys are discarded in the US.

We performed a single-center study of zero-time donor kidney biopsies performed between November 2005 and December 2014. Only those biopsies analyzed immediately using frozen tissue sections were utilized in the kidney accept/discard decision.

All the donor kidneys in our center had a zero-time biopsy (n=1358). Of these, 70 were analyzed immediately via frozen tissue sections: these donors were older, had a higher serum creatinine and were more likely to have hypertension, proteinuria and diabetes mellitus than those donors whose biopsies were not analyzed immediately (n=1288). Interestingly, there was no difference in cold ischemic time between the two groups (21.4±8.5 and 21.2±8.3 hours respectively). From these 70 potential donor kidney biopsies, 53% of organs were accepted and 47% were discarded. Donor age, serum creatinine, past history of hypertension or diabetes mellitus and cerebrovascular disease as the cause of death did not discriminate these groups. However, biopsies of discarded kidneys showed more glomerulosclerosis (25 ± 14 vs. 12 ± 15%, p <0.001), increased interstitial fibrosis and tubular atrophy (IFTA, 1.4 ± 0.8 vs. 0.4 ± 0.6, p <0.001) and more severe arteriolar (ah score: 2.2 ± 0.8 vs. 1.6 ± 0.9, p <0.02) and arterial lesions (cv score: 2.3 ± 0.9 vs. 1.7 ± 0.7, p =0.006). Finally, we used a propensity score matching to retrospectively select a group of kidney recipients who had similar donor zero-time histology (% glomerulosclerosis, IFTA, arteriosclerosis) and age to those donor kidneys discarded in our study. Interestingly, this retrospective group (n=33) had a similar graft survival at 2 and 8 years (85 and 70%, respectively) to all recipients in our center of kidneys from extended criteria donors (ECD) (n=647).

When performed, zero-time frozen tissue section analysis of potentially kidney donors let to roughly 50% organ turndown rate. However, pre-implantation histology did not dictate graft survival among ECD.

CITATION INFORMATION: Luque Y, Aubert O, Martinez F, Amrouche L, Tinel C, Galmiche L, Noel L.-H, Duong J.-P, Audenet F, Legendre C, Anglicheau D, Rabant M. Zero-Time Biopsy of Potential Donor Kidneys to Aid Decision-Making: A 9-Year Single-Center Experience. Am J Transplant. 2017;17 (suppl 3).

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