Assessing the reliability of rapid frozen tissue sections from pre-transplant kidney biopsies in DCD donors and correlations with clinico-pathological data: a pilot study
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Published on: June 17, 2020
Nadia Mansour1, Roberto Maria Battocchio1, Alessandra Storaci1,2
1Division of Pathology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, via F. Sforza 35, Milan, Italy.
Insights
Donations after circulatory death pose challenges impacting organ quality. This study validates frozen biopsies as a rapid alternative to formalin-fixed paraffin-embedded samples for assessing kidney damage and predicting transplant success.
Area of Science:
- Nephrology
- Transplantation Surgery
- Pathology
Background:
- Donations after circulatory death (DCD) present unique challenges compared to donations after brain death, including consent acquisition, resource needs, and time-sensitive organ assessment.
- Time-dependent factors in DCD negatively impact organs, leading to increased damage and potentially affecting transplant outcomes.
- Current organ evaluation relies on formalin-fixed paraffin-embedded (FFPE) samples, requiring a three-hour processing time, which can be a bottleneck in time-critical DCD scenarios.
Purpose of the Study:
- To investigate the reliability of extemporaneous frozen biopsies in identifying morphological alterations in DCD kidneys.
- To compare the diagnostic accuracy of frozen biopsy samples with standard FFPE samples.
- To correlate clinical data (terminal serum creatinine and warm ischemia time) with morphological changes to predict kidney transplant outcomes.
Main Methods:
- Retrospective analysis of kidney tissue samples from DCD donors.
- Comparison of morphological findings between extemporaneous frozen biopsies and FFPE samples.
- Correlation of histological findings with clinical parameters such as terminal serum creatinine and warm ischemia time.
Main Results:
- Frozen biopsies demonstrated reliability in identifying key morphological alterations, comparable to FFPE samples.
- Specific morphological alterations were correlated with terminal serum creatinine levels and warm ischemia time.
- The study identified potential fast strategies for predicting kidney transplant outcomes based on rapid biopsy assessment.
Conclusions:
- Extemporaneous frozen biopsies offer a viable and faster alternative for evaluating DCD kidney quality compared to traditional FFPE methods.
- Integrating clinical data with rapid histological assessment can aid in predicting kidney transplant success.
- These findings support the development of more efficient strategies for organ assessment in DCD, potentially improving transplant rates.
Abstract:
Compared to donations after brain death, donations after circulatory death present a series of difficulties: the acquisition of the family's consent, the need for qualified personnel and specific resources, death assessment, assessment of the organ, and graft care (pre- and post-transplant). These are all time-related factors that negatively impact the organ, resulting in increased tubular, glomerular, and vascular damage. The evaluation of the organ, as per today's standards, requires three hours for the preparation and processing of formalin-fixed paraffin-embedded (FFPE) samples. An alternative to this is the use of the extemporaneous frozen biopsy. However, frozen samples are considered a second choice in the decision-making process. This retrospective study investigates the reliability of the frozen samples in identifying a series of morphological alterations compared to the more accepted results from FFPE samples. Additionally, two important clinical data, terminal serum creatinine levels and warm ischemia time, were correlated to the presence of some morphological alterations in an attempt to find effective and fast strategies to predict the kidney transplant outcome.
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