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Improving Donated Kidney Use

PROCUREMENT BIOPSIES are commonly used to assess the health of a donated organ and predict the success of a transplant procedure, but new research, published in a study conducted by researchers at Columbia University Vagelos College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University, New York City, New York, USA, has highlighted a need to review the current assessment strategies applied to kidneys obtained from deceased donors.

Of the kidneys obtained from deceased donors, 20% of organs are discarded, most commonly as a result of findings from procurement biopsies. With this in mind, the research team reviewed the transplant procedure of 300 kidneys donated by deceased patients used in procedures from 2006–2009.

The organs had all undergone at least one procurement biopsy and had also undergone a reperfusion biopsy, the current gold standard for kidney assessment. Analyses of the results from the procurement and reperfusion biopsies showed poor agreement between the two strategies. Further to this in a population of 116 kidneys that had been subjected to multiple procurement biopsy showed significant disagreement between the procurement biopsies. “Limited reliance on procurement biopy histology will likely result in an improvement in organ utilisation by reducing the discard of kidneys attributable to these findings,” summarised Dr Sumit Mohan, University of Columbia.

The researchers hypothesised that some of the reasons behind the high discarded organ rate were that the results were interpreted by inexperienced pathologists. The research team called for all biopsy results to be reviewed by an experienced kidney pathologist; standardisation of biopsy techniques and reporting; and improved integration of biopsy data with other clinical information. Further studies have been called for to assess the reliability, repeatability, and validity of procurement biopsies to decrease the number of discarded organs.