Donor kidney biopsies: pathology matters, and so does the pathologist

Histologic scoring of pre-implantation biopsies of expanded-criteria donor (ECD) kidneys has proven useful for predicting post-implantation allograft performance and guiding transplant clinicians as to which kidneys to discard. However, there is considerable interobserver variability in scoring these biopsies, as well as disagreements between studies examining the value of different histologic parameters in predicting graft function. Azancot and co-workers demonstrate that these biopsies' prognostic value is highly dependent on their being examined by an experienced renal pathologist.