Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation

Krista L. Lentine; Abhijit S. Naik; Mark A. Schnitzler; Henry Randall; Jason R. Wellen; Bertram L. Kasiske; Gary Marklin; Diane Brockmeier; Matthew Cooper; Huiling Xiao; Zidong Zhang; Robert S. Gaston; Richard Rothweiler; David A. Axelrod

doi:10.1111/ajt.15325

Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation

Krista L. Lentine, Abhijit S. Naik, Mark A. Schnitzler, Henry Randall, Jason R. Wellen, Bertram L. Kasiske, Gary Marklin, Diane Brockmeier, Matthew Cooper, Huiling Xiao, Zidong Zhang, Robert S. Gaston, Richard Rothweiler, David A. Axelrod

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Abstract

The use of procurement biopsies in deceased donor kidney acceptance is controversial. We analyzed Scientific Registry of Transplant Recipients data (n = 59 328 allografts, 2014-2018) to describe biopsy practices across US organ procurement organizations (OPOs) and examine relationships with discards, using hierarchical modeling to account for OPO and donor factors. Median odds ratios (MORs) provide the median of the odds that allografts with identical reported traits would be biopsied or discarded from 2 randomly drawn OPOs. Biopsies were obtained for 52.7% of kidneys. Biopsy use rose in a graded manner with kidney donor profile index (KDPI). Biopsy rates differed significantly among OPOs (22.8% to 77.5%), even after adjustment for KDPI and other donor factors. Discard rates also varied from 6.6% to 32.1% across OPOs. After adjustment for donor factors and OPO, biopsy was associated with more than 3 times the likelihood of discard (adjusted odds ratio [_95%LCLaOR₉₅_%UCL], _3.293.51_3.76). This association was most pronounced for low-risk (KDPI <20) kidneys (aOR, _5.456.47_7.69), with minimal impact at KDPI >85 (aOR, _0.881.15_1.51). Adjusted MORs for kidney discard and biopsy were greatest for low-risk kidneys. Reducing the rate of unnecessary biopsy and improving the accuracy of histologic assessments in higher KDPI organs may help reduce graft discard rates.

Original language	English
Pages (from-to)	2241-2251
Number of pages	11
Journal	American Journal of Transplantation
Volume	19
Issue number	8
DOIs	https://doi.org/10.1111/ajt.15325
State	Published - Aug 2019

Keywords

Scientific Registry for Transplant Recipients (SRTR)
biopsy
clinical research/practice
donors and donation: deceased
health services and outcomes research
kidney transplantation/nephrology
organ procurement
organ procurement and allocation

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Lentine, K. L., Naik, A. S., Schnitzler, M. A., Randall, H., Wellen, J. R., Kasiske, B. L., Marklin, G., Brockmeier, D., Cooper, M., Xiao, H., Zhang, Z., Gaston, R. S., Rothweiler, R., & Axelrod, D. A. (2019). Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation. American Journal of Transplantation, 19(8), 2241-2251. https://doi.org/10.1111/ajt.15325

@article{da6734fce8844816855b9181a80064ba,

title = "Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation",

abstract = "The use of procurement biopsies in deceased donor kidney acceptance is controversial. We analyzed Scientific Registry of Transplant Recipients data (n = 59 328 allografts, 2014-2018) to describe biopsy practices across US organ procurement organizations (OPOs) and examine relationships with discards, using hierarchical modeling to account for OPO and donor factors. Median odds ratios (MORs) provide the median of the odds that allografts with identical reported traits would be biopsied or discarded from 2 randomly drawn OPOs. Biopsies were obtained for 52.7% of kidneys. Biopsy use rose in a graded manner with kidney donor profile index (KDPI). Biopsy rates differed significantly among OPOs (22.8% to 77.5%), even after adjustment for KDPI and other donor factors. Discard rates also varied from 6.6% to 32.1% across OPOs. After adjustment for donor factors and OPO, biopsy was associated with more than 3 times the likelihood of discard (adjusted odds ratio [95%LCLaOR95%UCL], 3.293.513.76). This association was most pronounced for low-risk (KDPI <20) kidneys (aOR, 5.456.477.69), with minimal impact at KDPI >85 (aOR, 0.881.151.51). Adjusted MORs for kidney discard and biopsy were greatest for low-risk kidneys. Reducing the rate of unnecessary biopsy and improving the accuracy of histologic assessments in higher KDPI organs may help reduce graft discard rates.",

keywords = "Scientific Registry for Transplant Recipients (SRTR), biopsy, clinical research/practice, donors and donation: deceased, health services and outcomes research, kidney transplantation/nephrology, organ procurement, organ procurement and allocation",

author = "Lentine, {Krista L.} and Naik, {Abhijit S.} and Schnitzler, {Mark A.} and Henry Randall and Wellen, {Jason R.} and Kasiske, {Bertram L.} and Gary Marklin and Diane Brockmeier and Matthew Cooper and Huiling Xiao and Zidong Zhang and Gaston, {Robert S.} and Richard Rothweiler and Axelrod, {David A.}",

note = "Funding Information: This work was conducted under the auspices of the Hennepin Healthcare Research Institute (HHRI), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government-sponsored work, there are no restrictions on its use. The data reported here have been supplied by HHRI as the contractor for SRTR. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing. An abstract describing portions of this work was accepted for presentation at the 2019 American Transplant Congress (June 2, 2019, Boston, MA). Publisher Copyright: {\textcopyright} 2019 The American Society of Transplantation and the American Society of Transplant Surgeons",

year = "2019",

month = aug,

doi = "10.1111/ajt.15325",

language = "English",

volume = "19",

pages = "2241--2251",

journal = "American Journal of Transplantation",

issn = "1600-6135",

number = "8",

}

Lentine, KL, Naik, AS, Schnitzler, MA, Randall, H, Wellen, JR, Kasiske, BL, Marklin, G, Brockmeier, D, Cooper, M, Xiao, H, Zhang, Z, Gaston, RS, Rothweiler, R & Axelrod, DA 2019, 'Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation', American Journal of Transplantation, vol. 19, no. 8, pp. 2241-2251. https://doi.org/10.1111/ajt.15325

TY - JOUR

T1 - Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation

AU - Lentine, Krista L.

AU - Naik, Abhijit S.

AU - Schnitzler, Mark A.

AU - Randall, Henry

AU - Wellen, Jason R.

AU - Kasiske, Bertram L.

AU - Marklin, Gary

AU - Brockmeier, Diane

AU - Cooper, Matthew

AU - Xiao, Huiling

AU - Zhang, Zidong

AU - Gaston, Robert S.

AU - Rothweiler, Richard

AU - Axelrod, David A.

N1 - Funding Information: This work was conducted under the auspices of the Hennepin Healthcare Research Institute (HHRI), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government-sponsored work, there are no restrictions on its use. The data reported here have been supplied by HHRI as the contractor for SRTR. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing. An abstract describing portions of this work was accepted for presentation at the 2019 American Transplant Congress (June 2, 2019, Boston, MA). Publisher Copyright: © 2019 The American Society of Transplantation and the American Society of Transplant Surgeons

PY - 2019/8

Y1 - 2019/8

N2 - The use of procurement biopsies in deceased donor kidney acceptance is controversial. We analyzed Scientific Registry of Transplant Recipients data (n = 59 328 allografts, 2014-2018) to describe biopsy practices across US organ procurement organizations (OPOs) and examine relationships with discards, using hierarchical modeling to account for OPO and donor factors. Median odds ratios (MORs) provide the median of the odds that allografts with identical reported traits would be biopsied or discarded from 2 randomly drawn OPOs. Biopsies were obtained for 52.7% of kidneys. Biopsy use rose in a graded manner with kidney donor profile index (KDPI). Biopsy rates differed significantly among OPOs (22.8% to 77.5%), even after adjustment for KDPI and other donor factors. Discard rates also varied from 6.6% to 32.1% across OPOs. After adjustment for donor factors and OPO, biopsy was associated with more than 3 times the likelihood of discard (adjusted odds ratio [95%LCLaOR95%UCL], 3.293.513.76). This association was most pronounced for low-risk (KDPI <20) kidneys (aOR, 5.456.477.69), with minimal impact at KDPI >85 (aOR, 0.881.151.51). Adjusted MORs for kidney discard and biopsy were greatest for low-risk kidneys. Reducing the rate of unnecessary biopsy and improving the accuracy of histologic assessments in higher KDPI organs may help reduce graft discard rates.

AB - The use of procurement biopsies in deceased donor kidney acceptance is controversial. We analyzed Scientific Registry of Transplant Recipients data (n = 59 328 allografts, 2014-2018) to describe biopsy practices across US organ procurement organizations (OPOs) and examine relationships with discards, using hierarchical modeling to account for OPO and donor factors. Median odds ratios (MORs) provide the median of the odds that allografts with identical reported traits would be biopsied or discarded from 2 randomly drawn OPOs. Biopsies were obtained for 52.7% of kidneys. Biopsy use rose in a graded manner with kidney donor profile index (KDPI). Biopsy rates differed significantly among OPOs (22.8% to 77.5%), even after adjustment for KDPI and other donor factors. Discard rates also varied from 6.6% to 32.1% across OPOs. After adjustment for donor factors and OPO, biopsy was associated with more than 3 times the likelihood of discard (adjusted odds ratio [95%LCLaOR95%UCL], 3.293.513.76). This association was most pronounced for low-risk (KDPI <20) kidneys (aOR, 5.456.477.69), with minimal impact at KDPI >85 (aOR, 0.881.151.51). Adjusted MORs for kidney discard and biopsy were greatest for low-risk kidneys. Reducing the rate of unnecessary biopsy and improving the accuracy of histologic assessments in higher KDPI organs may help reduce graft discard rates.

KW - Scientific Registry for Transplant Recipients (SRTR)

KW - biopsy

KW - clinical research/practice

KW - donors and donation: deceased

KW - health services and outcomes research

KW - kidney transplantation/nephrology

KW - organ procurement

KW - organ procurement and allocation

UR - http://www.scopus.com/inward/record.url?scp=85064487334&partnerID=8YFLogxK

U2 - 10.1111/ajt.15325

DO - 10.1111/ajt.15325

M3 - Article

C2 - 30809941

AN - SCOPUS:85064487334

SN - 1600-6135

VL - 19

SP - 2241

EP - 2251

JO - American Journal of Transplantation

JF - American Journal of Transplantation

IS - 8

ER -

Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation

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