title: The reproducibility and predictive value on outcome of renal biopsies from expanded criteria donors.
abstract: Reproducibility and predictive value on outcome are the main criteria to evaluate the utility of histological scores. Here we analyze the reproducibility of donor biopsy assessment by different on-call pathologists and the retrospective evaluation by a single renal pathologist blinded to clinical outcomes. We also evaluate the predictive value on graft outcome of both evaluations. A biopsy was performed in donors with any of the following: age≥55 years, hypertension, diabetes, creatinine>1.5 mg/dl, or stroke. Glomerulosclerosis, interstitial fibrosis, tubular atrophy, intimal thickening, and arteriolar hyalinosis evaluated according to the Banff criteria were added to obtain a chronic score. Biopsies were classified as mild (≥3), intermediate (4-5), or advanced (6-7) damage, and unacceptable (≥8) for transplantation of 127 kidneys biopsied. Weighted κ value between both readings was 0.41 (95% CI: 0.28-0.54). Evaluation of biopsies by the renal pathologist was significantly and independently associated with estimated 12-month glomerular filtration rate and a significant composite outcome variable, including death-censored graft survival and time to reach an estimated glomerular filtration rate<30 ml/min per 1.73 m2. Thus, there was no association between readings of on-call pathologists and outcome. The lack of association between histological scores obtained by the on-call pathologists and graft outcome suggests that a specific training on renal pathology is recommended to optimize the use of kidneys retrieved from expanded criteria donors.
authors.affiliation: Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: M Antonieta
authors.initials: MA
authors.lastname: Azancot
authors.affiliation: Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Moreso
authors.affiliation: Department of Pathology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Salcedo
authors.affiliation: Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Cantarell
authors.affiliation: Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Perello
authors.affiliation: Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: Irina B
authors.initials: IB
authors.lastname: Torres
authors.affiliation: Department of Pathology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: Angeles
authors.initials: A
authors.lastname: Montero
authors.affiliation: Department of Urology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Trilla
authors.affiliation: Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: Joana
authors.initials: J
authors.lastname: Sellarés
authors.affiliation: Department of Urology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Morote
authors.affiliation: Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seron
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D046148:Donor Selection; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome