Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA,
Nephron. 2019;142(1):34-39. doi: 10.1159/000499452. Epub 2019 Apr 1.
Results of procurement biopsies often drive the decision to discard kidneys from deceased donors with advanced age or comorbidities. However, the criteria to perform, process, and score procurement graft biopsies are not standardized. Subject of Review: A recent retrospective, single-center study by Carpenter et al. [Clin J Am Soc Nephrol 2018; 13: 1876-1885] compared the scores obtained from 270 consecutive frozen kidney sections of biopsies at time of procurement with those of paraffin-embedded sections of biopsies at reperfusion and the correlation of both biopsy scores with graft survival. In 116 kidneys, procurement biopsies were repeated, allowing to test the reproducibility of this technique. Procurement biopsies were poorly reproducible, did not correlate with scores obtained with paraffin-embedded reperfusion biopsies, and were not significantly associated with transplant outcomes, while reperfusion biopsies provided an excellent prediction of graft survival. Based on these findings, the authors suggest "an urgent need to reexamine the role of procurement biopsies during allocation given their high resource requirements and association with discards." Second Opinion: Carpenter's paper is important because it emphasizes the crucial role of correct histological evaluation of kidney grafts to accurately predict their survival. In this study, procurement biopsies were frozen and read by on-call pathologists, often with no specific training in renal pathology, while reperfusion sections were paraffin embedded and scored by experienced renal pathologists at Columbia University, New York, NY, USA. This methodological difference per se represents an obvious explanation for the poor concordance between the 2 assessments. Use of wedge biopsies in procurement samples versus core-needle samples in reperfusion biopsies may further account for the discrepancies between scores even in seemingly objective measurements, such as the percentage of glomerulosclerosis. Therefore, these data should not mislead us regarding the importance of procurement biopsies to define organ suitability for transplantation. Rather, they should prompt more studies aimed at optimizing the strategies to score these samples properly for optimal organ allocation.
采购活检的结果通常决定了是否放弃患有高龄或合并症的已故供者的肾脏。然而，进行、处理和评分采购移植物活检的标准尚未标准化。
Carpenter 等人最近进行了一项回顾性、单中心研究[Clin J Am Soc Nephrol 2018; 13: 1876-1885]，比较了在采购时进行的 270 例连续冷冻切片与再灌注时进行的石蜡包埋活检的评分，并比较了两种活检评分与移植物存活率的相关性。在 116 例肾脏中重复进行了采购活检，以检验该技术的可重复性。采购活检的重复性差，与再灌注活检的石蜡包埋评分不相关，与移植结局也无显著相关性，而再灌注活检能很好地预测移植物的存活率。基于这些发现，作者建议“鉴于采购活检需要大量资源且与放弃供肾有关，迫切需要重新审视其在分配中的作用。”
Carpenter 的论文很重要，因为它强调了正确评估肾脏移植物的组织学对准确预测其存活率的关键作用。在这项研究中，采购活检被冷冻并由值班病理学家进行解读，他们通常没有肾脏病理的专门培训，而再灌注切片则被纽约哥伦比亚大学的经验丰富的肾脏病理学家进行石蜡包埋和评分。这种方法学上的差异本身就是两种评估之间一致性差的一个明显解释。在采购样本中使用楔形活检与在再灌注活检中使用芯针活检可能会进一步导致评分之间的差异，即使在肾小球硬化等看似客观的测量中也是如此。因此，这些数据不应误导我们采购活检对于确定器官是否适合移植的重要性。相反，它们应该促使我们进行更多的研究，以优化评分这些样本的策略，从而实现最佳的器官分配。
