Assessment of donor biopsies

Area of Science:

• Nephrology
• Transplantation
• Pathology

Background:

• Preimplantation biopsies are vital for assessing donor kidneys, particularly those from extended criteria donors.
• Current practices for evaluating donor biopsies lack standardization, impacting kidney allocation.
• Kidney discards in the USA are frequently linked to preimplantation biopsy findings.

Purpose of the Study:

• To offer a comprehensive review of donor biopsy assessment.
• To explore challenges and opportunities in using preimplantation biopsies for transplant allocation.
• To focus on technical procedures and histological scoring of donor biopsies.

Main Methods:

• Review of current literature on preimplantation donor kidney biopsies.
• Analysis of histological variables and scoring systems.
• Discussion of technical aspects, including biopsy methods (needle vs. punch).

Main Results:

• Preimplantation biopsy results are a primary driver for discarding extended criteria donor kidneys in the USA.
• A lack of consensus exists regarding biopsy workup, reporting, and the significance of findings in allocation.
• Clinical risk factor scores may guide decisions on when to perform preimplantation biopsies.
• Punch biopsies offer a viable alternative to needle biopsies for surgeons.

Conclusions:

• Donor biopsies serve as essential "zero-hour" benchmarks for post-transplant comparisons.
• No single histological variable or score perfectly predicts outcomes.
• Preimplantation biopsy results must be integrated with all available donor and recipient information for optimal interpretation.