title: Peritransplant kidney biopsies: comparison of pathologic interpretations and practice patterns of organ procurement organizations.
abstract: The preimplantation kidney biopsy affects utilization by diagnosing glomerulosclerosis, interstitial fibrosis (IF), arteriosclerosis, and arteriolar hyalinosis. Organ procurement organizations (OPOs) determine whether a donor warrants this biopsy and the donor hospital pathologists (DHPs) report on an OPO-specific pathology interpretation form. Biopsy slides from 40 deceased donor kidneys transplanted at our institution were used to compare interpretations between our transplant pathologist and the DHPs. Thirty-three of these kidneys also had post-perfusion biopsies (PPB). All 58 OPOs were queried for criteria used to request a preimplantation biopsy, and their pathology interpretation forms were also analyzed. The transplant and DHPs had substantial agreement for percent glomerulosclerosis with 75% of biopsies being interpreted within five percentage points. Concordance for IF was poor. The DHP rarely reported arterial pathology. Seventy percent of preimplantation and PPB were read similarly for glomerulosclerosis; concordance for other lesions was weaker. There were no cues for arterial disease on our OPO's pathology interpretation form. Criteria for obtaining a preimplantation biopsy lacked uniformity for the 21 OPOs with a self-generated policy. The pathology interpretation forms varied widely among the OPOs. Current OPO practices with regard to the preimplantation biopsy should be improved.
authors.affiliation: Division of Nephrology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA. pooja.singh@jefferson.edu
authors.forename: Pooja
authors.initials: P
authors.lastname: Singh
authors.forename: John L
authors.initials: JL
authors.lastname: Farber
authors.forename: Cataldo
authors.initials: C
authors.lastname: Doria
authors.forename: George C
authors.initials: GC
authors.lastname: Francos
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gulati
authors.forename: Carlo B
authors.initials: CB
authors.lastname: Ramirez
authors.forename: Warren R
authors.initials: WR
authors.lastname: Maley
authors.forename: Adam M
authors.initials: AM
authors.lastname: Frank
mesh_terms: D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000601:surgery*; D007674:Kidney Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000592:standards*; D010818:Practice Patterns, Physicians'; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D014652:Vascular Diseases / Q000175:diagnosis*