title: The cutting (w)edge--comparative evaluation of renal baseline biopsies obtained by two different methods.
abstract: BACKGROUND
  The assessment of donor-derived damage of transplanted kidneys might be instrumental for estimating donor organ quality and for predicting short- and long-term organ outcome. In the present study, we report a new standardized method for obtaining pre-transplant kidney biopsy specimens. Instead of taking wedge biopsies (WBs), a skin punch biopsy (PB) tool was utilized to obtain standardized biopsy samples that also represented deeper cortical zones.
  
  
  METHODS
  We compared 147 PB specimens and 114 WBs with respect to the number of glomeruli and arterial vessels they contained. The performance of the two biopsy methods in detecting glomerular damage, interstitial fibrosis/tubular atrophy (IF/TA) and arteriosclerosis was determined by evaluation of subsequent transplant core biopsies of the patients. Statistical comparison employed Kruskal-Wallis and kappa (κ) tests.
  
  
  RESULTS
  Significantly more PB samples (89%) than WBs (66%) were diagnostically adequate according to the Banff criteria. Despite a higher number of glomeruli in WBs (34.6 versus 21.7 in punch biopsies), arteries were present in only 68% of WBs but could be found in 93% of punch biopsies. The comparison of findings in pre-transplant biopsies with lesions in corresponding post-transplant core biopsies revealed a superior diagnostic concordance for IF/TA and arteriosclerosis for punch biopsies than for WBs, reaching kappa values of 0.823 versus 0.729 and 0.661 versus 0.516, respectively.
  
  
  CONCLUSIONS
  The use of skin PB tools for obtaining baseline biopsies from transplanted kidneys is a safe and effective method for assessment of donor-derived damage of the organ.
authors.affiliation: Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Bago-Horvath
authors.forename: Nicolas
authors.initials: N
authors.lastname: Kozakowski
authors.forename: Afschin
authors.initials: A
authors.lastname: Soleiman
authors.forename: Martin
authors.initials: M
authors.lastname: Bodingbauer
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mühlbacher
authors.forename: Heinz
authors.initials: H
authors.lastname: Regele
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods* / Q000592:standards; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007678:Kidney Glomerulus / Q000098:blood supply / Q000473:pathology; D016030:Kidney Transplantation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000473:pathology; D015203:Reproducibility of Results; D014019:Tissue Donors; D055815:Young Adult