Are transplant centers unnecessarily discarding donated kidneys?

July 25, 2017

Organ transplants, once a procedure that was on the outer frontiers of surgical medicine, have become commonplace, and life-saving. Kidney transplantation is often the last resort for patients with otherwise terminal chronic kidney disease (CKD). It is widely known, however, that there are often long waiting lists for donated organs, and some patients die waiting.

In that context, a news release that recently crossed my desk piqued my interest. Researchers have found that discarding donated kidneys on the basis of biopsy findings may be inappropriate. The findings, which appeared recently in the Journal of the American Society of Nephrology (JASN), may help address the organ shortage by keeping valuable organs from being thrown away. The article is titled “Impact of Reperfusion Renal Allograft Biopsy Findings on Renal Transplantation Outcomes.”

According to the news release, discard rates for deceased donor kidneys in the United States are at an all-time high, and transplant centers frequently cite biopsy findings as the reason for not accepting kidneys obtained from donors for transplantation. The importance of biopsy results in determining how well a kidney will function post-transplant remains unclear, however.

To assess the true impact of biopsy results on long-term outcomes, Sumit Mohan, MD, MPH, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, and his colleagues analyzed nearly 1,000 kidney biopsy samples that were processed under ideal circumstances and read by experienced renal pathologists.

The investigators found that biopsy results did not appear to impact long-term patient outcomes following transplantation of kidneys from living donors. Also, living donor kidneys with suboptimal biopsy results had better outcomes than deceased donor kidneys with optimal results.

Outcomes following kidney transplantation using deceased donor kidneys were influenced by biopsy findings; however, the team estimated that even transplantation with kidneys with the worst biopsy findings would result in several additional years of life for a patient compared with remaining on dialysis.

“Also, 73 percent of deceased donor kidneys with suboptimal biopsy results were still functioning at five years, suggesting that discards based on biopsy findings may be inappropriate,” says Dr. Mohan.

This is interesting indeed, especially when we consider the likelihood that CKD incidence, already high, will continue to increase. As Jack Zakowski, PhD, FACB, points out in his article in this issue of MLO, “Optimizing and standardizing testing to address the threat of chronic kidney disease”, up to two million Americans have end-stage renal disease (ESRD), and that number is increasing by five to seven percent a year. The demand for both hemodialysis and kidney transplantation is certainly going to increase as well. And as Dr. Zakowski also points out, only 35 percent of people on dialysis survive for five years.

If new protocols are developed for rejecting (and accepting) donated kidneys, and more transplants are performed, that means more business for labs. CBCs, glucose testing, evaluations of liver and renal function, and therapeutic drug monitoring all follow transplantations. As always, the lab will play a crucial role in maximizing the chances of positive patient outcomes.

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