Rethinking procurement biopsy in donors with normal renal function: A barrier to kidney utilization without survival...

Area of Science:

• Nephrology
• Transplantation Surgery
• Pathology

Background:

• Procurement biopsy is standard in deceased donor kidney transplantation, but its utility in kidneys with preserved function is debated.
• Concerns include sampling errors, variable interpretation, and potential organ discard based on biopsy findings.
• The impact of procurement biopsy on decision-making and graft outcomes in donors with normal renal function remains unclear.

Purpose of the Study:

• To evaluate the clinical value of procurement biopsy in deceased kidney donors with preserved renal function.
• To determine if biopsy causes delays or misclassification without improving transplant outcomes.
• To assess the association between biopsy and organ discard rates.

Main Methods:

• Analysis of national Organ Procurement and Transplantation Network data (2014-2024) for deceased donor kidneys with preserved function (eGFR ≥ 60).
• Propensity-score matching (1:1) to create balanced biopsy and non-biopsy cohorts.
• Center-clustered Cox models and mediation analysis to assess biopsy's association with graft failure, cold ischemia time, and delayed graft function.

Main Results:

• Nearly half of recovered kidneys underwent biopsy, with a significantly higher discard rate (28.2% vs. 4.4%) compared to non-biopsied kidneys.
• Biopsy was associated with increased graft failure risk (HR=1.12) and prolonged cold ischemia time by 42 minutes.
• No significant improvement in clinical benefit was observed with biopsy beyond standard clinical assessment.

Conclusions:

• Procurement biopsy in deceased donors with normal renal function provides no prognostic value.
• Biopsy increases organ discard rates and ischemic delays, potentially hindering the utilization of viable kidneys.
• Routine procurement biopsy is not recommended for deceased kidney donors with preserved renal function.