Deceased Donor Procurement Biopsy Practices, Interpretation, and Histology-Based Decision-Making: A Survey of US Kidney Transplant Centers.

Autor:	Lentine KL; Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA., Fleetwood VA; Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA., Caliskan Y; Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA., Randall H; Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA., Wellen JR; Washington University, St. Louis, Missouri, USA., Lichtenberger M; Washington University, St. Louis, Missouri, USA., Dedert C; Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA., Rothweiler R; Mid-America Transplant, St. Louis, Missouri, USA., Marklin G; Mid-America Transplant, St. Louis, Missouri, USA., Brockmeier D; Mid-America Transplant, St. Louis, Missouri, USA., Schnitzler MA; Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA., Husain SA; Columbia University, New York, New York, USA., Mohan S; Columbia University, New York, New York, USA., Kasiske BL; Hennepin County Medical Center, Minneapolis, Minnesota, USA., Cooper M; Med-Star Georgetown Transplant Institute, Washington, DC, USA., Mannon RB; University of Nebraska, Omaha, Nebraska, USA., Axelrod DA; University of Iowa, Iowa City, Iowa, USA.
Jazyk:	angličtina
Zdroj:	Kidney international reports [Kidney Int Rep] 2022 Mar 28; Vol. 7 (6), pp. 1268-1277. Date of Electronic Publication: 2022 Mar 28 (Print Publication: 2022).
DOI:	10.1016/j.ekir.2022.03.021
Abstrakt:	Introduction: The utility of kidney procurement biopsies is controversial. Understanding the current landscape of how clinicians obtain and use biopsies in organ evaluation may help inform consensus-building efforts. Methods: An electronic survey was distributed to clinicians at US kidney transplant programs (April 22, 2021-June 30, 2021) to evaluate donor biopsy indications, frequency, processing and interpretation, and impact of findings on practices. Results: Responses from staff involved in organ acceptance (73% surgeons, 20% nephrologists, 6% coordinators) at 95 transplant centers were analyzed, representing 40% of US transplant centers and 50% of recent deceased donor kidney transplant volume. More than a third of centers (35%) reported obtaining procurement biopsies on most-to-all kidneys. Most clinicians decided when to biopsy jointly with the Organ Procurement Organization (OPO) (82%) based on formal criteria for the decision (72%), although 41% reported having requested a biopsy outside of the criteria. Most respondents used a semiquantitative scoring system for interpretation (57%). Many respondents reported rarely or never having access to renal specialty pathologists (37%) or to telepathology (59%). Most respondents reported that a favorable biopsy result would encourage them to accept a "marginal" donor kidney (72%); nearly half (46%) indicated that an unfavorable biopsy result would lead to decline of a standard criteria kidney. Conclusion: Procurement biopsies are commonly used in organ acceptance decisions despite inconsistent access to experienced renal pathologists and heterogeneous approaches to criteria, scoring, and interpretation. Ongoing study and consensus building are needed to direct procurement biopsy practice toward increasing organ utilization and reducing allocation inefficiency. (© 2022 International Society of Nephrology. Published by Elsevier Inc.)
Databáze:	MEDLINE
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