title: Histological assessment of pre-transplant kidney biopsies is reproducible and representative.
abstract: OBJECTIVE
  Histological examination of pre-transplant renal biopsy specimens can be used to select grafts from older donors after cardiac death (DCD) with a satisfactory transplant outcome. The aim was to determine whether such biopsy specimens can be reproducibly scored between pathologists and are representative of the whole kidney.
  
  
  RESULTS
  In renal biopsy specimens from DCD aged >or=60 years (n = 44), globally sclerosed glomeruli, vascular narrowing, tubular atrophy and interstitial fibrosis were scored by three independent pathologists according to the Pirani scoring system. Interobserver agreement on the sum of scores improved considerably with the introduction of a combined tubulo-interstitial scoring system (intraclass correlation coefficient increased from 0.38 to 0.64). In small needle biopsy specimens (n = 144) obtained at autopsy, estimates of the proportion of globally sclerosed glomeruli were more precise with increasing sample size. Reasonably precise estimates may be obtained from specimens with at least seven glomeruli.
  
  
  CONCLUSIONS
  It is feasible to implement pre-transplant renal biopsy specimen analysis as a selection criterion in clinical practice in order to accept kidneys from marginal donors for transplantation.
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. m.snoeijs@mumc.nl
authors.forename: Maarten G J
authors.initials: MG
authors.lastname: Snoeijs
authors.forename: Liesbeth A
authors.initials: LA
authors.lastname: Boonstra
authors.forename: Wim A
authors.initials: WA
authors.lastname: Buurman
authors.forename: Roel
authors.initials: R
authors.lastname: Goldschmeding
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: van Suylen
authors.forename: L W Ernest
authors.initials: LW
authors.lastname: van Heurn
authors.forename: Carine J
authors.initials: CJ
authors.lastname: Peutz-Kootstra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000175:diagnosis; D001706:Biopsy; D003643:Death; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology*; D016030:Kidney Transplantation / Q000473:pathology*; D007684:Kidney Tubules / Q000473:pathology; D008875:Middle Aged; D015588:Observer Variation; D012598:Sclerosis / Q000175:diagnosis; D014019:Tissue Donors; D019737:Transplants