Departments of Surgery and.
Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
Clin J Am Soc Nephrol. 2018 Dec 7;13(12):1876-1885. doi: 10.2215/CJN.04150418. Epub 2018 Oct 25.
Biopsies taken at deceased donor kidney procurement continue to be cited as a leading reason for discard; however, the reproducibility and prognostic capability of these biopsies are controversial.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We compiled a retrospective, single-institution, continuous cohort of deceased donor kidney transplants performed from 2006 to 2009. Procurement biopsy information-percentage of glomerulosclerosis, interstitial fibrosis/tubular atrophy, and vascular disease-was obtained from the national transplant database. Using univariable, multivariable, and time-to-event analyses for death-censored graft survival, we compared procurement frozen section biopsy reports with reperfusion paraffin-embedded biopsies read by trained kidney pathologists (=270). We also examined agreement for sequential procurement biopsies performed on the same kidney (=116 kidneys).
For kidneys on which more than one procurement biopsy was performed (=116), category agreement was found in only 64% of cases (=0.14). For all kidneys (=270), correlation between procurement and reperfusion biopsies was poor: overall, biopsies were classified into the same category (optimal versus suboptimal) in only 64% of cases (=0.25). This discrepancy was most pronounced when categorizing percentage of glomerulosclerosis, which had 63% agreement (=0.15). Interstitial fibrosis/tubular atrophy and vascular disease had agreement rates of 82% (=0.13) and 80% (=0.15), respectively. Ninety-eight (36%) recipients died, and 56 (21%) allografts failed by the end of follow-up. Reperfusion biopsies were more prognostic than procurement biopsies (hazard ratio for graft failure, 2.02; 95% confidence interval, 1.09 to 3.74 versus hazard ratio for graft failure, 1.30; 95% confidence interval, 0.61 to 2.76), with procurement biopsies not significantly associated with graft failure.
We found that procurement biopsies are poorly reproducible, do not correlate well with paraffin-embedded reperfusion biopsies, and are not significantly associated with transplant outcomes.
在已故供体肾脏获取过程中进行的活检仍然是导致器官废弃的主要原因；然而，这些活检的可重复性和预后能力存在争议。
设计、地点、参与者和测量：我们汇编了 2006 年至 2009 年进行的已故供体肾脏移植的回顾性、单机构、连续队列。从国家移植数据库中获取获取活检信息-肾小球硬化、间质纤维化/肾小管萎缩和血管疾病的百分比。使用单变量、多变量和时间事件分析进行死亡censored 移植物存活，我们将获取的冷冻切片活检报告与由经过培训的肾脏病理学家阅读的再灌注石蜡包埋活检进行了比较（=270）。我们还检查了对同一肾脏进行的连续获取活检的一致性（=116 个肾脏）。
对于进行了不止一次获取活检的肾脏（=116），仅在 64%的情况下发现类别一致性（=0.14）。对于所有肾脏（=270），获取和再灌注活检之间的相关性较差：总体而言，只有 64%的情况下活检被归类为同一类别（最佳与次优）（=0.25）。当对肾小球硬化的百分比进行分类时，这种差异最为明显，其一致性为 63%（=0.15）。间质纤维化/肾小管萎缩和血管疾病的一致性分别为 82%（=0.13）和 80%（=0.15）。98 名（36%）受者死亡，56 名（21%）移植物在随访结束时失败。再灌注活检比获取活检更具预后意义（移植物失败的危险比，2.02；95%置信区间，1.09 至 3.74 与移植物失败的危险比，1.30；95%置信区间，0.61 至 2.76），而获取活检与移植物失败无显著相关性。
我们发现，获取活检的可重复性差，与石蜡包埋再灌注活检相关性差，与移植结果无显著相关性。
