Skip to main content

Advertisement

SpringerLink
Log in

German recommendations for pretransplantation donor kidney biopsies

  • REVIEW ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

This manuscript reviews the data about the histopathologic and develops recommendations to standardise and improve the biopsy procedure, the biopsy handling, the histopathological evaluation, the communication of results and the collection of data from pretransplantation kidney biopsies of deceased donors in Germany.

Methods

The recommendations are based on this literature review, on discussions at two workshops held by the German Society of Pathology and the German Organ Transplantation Foundation and on personal experiences of the authors.

Results

These German recommendations advocate the use of punch biopsies, paraffin embedding and detailed descriptive reporting of histopathological findings.

Conclusions

These recommendations constitute only a starting point. Periodical revisions will help to simplify and optimise the recommendations with the ultimate goal to prospectively gather data for the elaboration of a computer-based algorithm that allows the exact prediction of transplantation outcome for a given match of donor and recipient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Munivenkatappa RB, Schweitzer EJ, Papadimitriou JC, Drachenberg CB, Thom KA, Perencevich EN, Haririan A, Rasetto F, Cooper M, Campos L, Barth RN, Bartlett ST, Philosophe B (2008) The Maryland aggregate pathology index: a deceased donor kidney biopsy scoring system for predicting graft failure. Am J Transplant 8(11):2316–2324. doi:10.1111/j.1600-6143.2008.02370.x

    Article  CAS  PubMed  Google Scholar 

  2. Aubert O, Kamar N, Vernerey D, Viglietti D, Martinez F, Duong-Van-Huyen JP, Eladari D, Empana JP, Rabant M, Verine J, Rostaing L, Congy N, Guilbeau-Frugier C, Mourad G, Garrigue V, Morelon E, Giral M, Kessler M, Ladriere M, Delahousse M, Glotz D, Legendre C, Jouven X, Lefaucheur C, Loupy A (2015) Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study. BMJ 351:h3557. doi:10.1136/bmj.h3557

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cannon RM, Brock GN, Garrison RN, Smith JW, Marvin MR, Franklin GA (2013) To pump or not to pump: a comparison of machine perfusion vs cold storage for deceased donor kidney transplantation. J Am Coll Surg 216(4):625–633. doi:10.1016/j.jamcollsurg.2012.12.025, discussion 633–624

    Article  PubMed  Google Scholar 

  4. Nogueira JM, Haririan A, Jacobs SC, Weir MR, Hurley HA, Al-Qudah HS, Phelan M, Drachenberg CB, Bartlett ST, Cooper M (2009) The detrimental effect of poor early graft function after laparoscopic live donor nephrectomy on graft outcomes. Am J Transplant 9(2):337–347. doi:10.1111/j.1600-6143.2008.02477.x

    Article  CAS  PubMed  Google Scholar 

  5. Narayanan R, Cardella CJ, Cattran DC, Cole EH, Tinckam KJ, Schiff J, Kim SJ (2010) Delayed graft function and the risk of death with graft function in living donor kidney transplant recipients. Am J Kidney Dis 56(5):961–970. doi:10.1053/j.ajkd.2010.06.024

    Article  PubMed  Google Scholar 

  6. Tapiawala SN, Tinckam KJ, Cardella CJ, Schiff J, Cattran DC, Cole EH, Kim SJ (2010) Delayed graft function and the risk for death with a functioning graft. J Am Soc Nephrol 21(1):153–161. doi:10.1681/ASN.2009040412

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lopes JA, Moreso F, Riera L, Carrera M, Ibernon M, Fulladosa X, Grinyo JM, Seron D (2005) Evaluation of pre-implantation kidney biopsies: comparison of Banff criteria to a morphometric approach. Kidney Int 67(4):1595–1600. doi:10.1111/j.1523-1755.2005.00241.x

    Article  PubMed  Google Scholar 

  8. Remuzzi G, Cravedi P, Perna A, Dimitrov BD, Turturro M, Locatelli G, Rigotti P, Baldan N, Beatini M, Valente U, Scalamogna M, Ruggenenti P (2006) Long-term outcome of renal transplantation from older donors. N Engl J Med 354(4):343–352. doi:10.1056/NEJMoa052891

    Article  CAS  PubMed  Google Scholar 

  9. Anglicheau D, Loupy A, Lefaucheur C, Pessione F, Letourneau I, Cote I, Gaha K, Noel LH, Patey N, Droz D, Martinez F, Zuber J, Glotz D, Thervet E, Legendre C (2008) A simple clinico-histopathological composite scoring system is highly predictive of graft outcomes in marginal donors. Am J Transplant 8(11):2325–2334. doi:10.1111/j.1600-6143.2008.02394.x

    Article  CAS  PubMed  Google Scholar 

  10. De Vusser K, Lerut E, Kuypers D, Vanrenterghem Y, Jochmans I, Monbaliu D, Pirenne J, Naesens M (2013) The predictive value of kidney allograft baseline biopsies for long-term graft survival. J Am Soc Nephrol. doi:10.1681/ASN.2012111081

    PubMed  PubMed Central  Google Scholar 

  11. Applying the GRADE methodology to SIGN guidelines: core principles. Scottish Intercollegiate Guidelines Network. http://www.sign.ac.uk/pdf/gradeprincipals.pdf. Accessed 08.13.2015 2015

  12. Hopfer H, Kemeny E (2013) Assessment of donor biopsies. Curr Opin Organ Transplant 18(3):306–312. doi:10.1097/MOT.0b013e3283607a6e

    Article  PubMed  Google Scholar 

  13. Bago-Horvath Z, Kozakowski N, Soleiman A, Bodingbauer M, Muhlbacher F, Regele H (2012) The cutting (w)edge--comparative evaluation of renal baseline biopsies obtained by two different methods. Nephrol Dial Transplant 27(8):3241–3248. doi:10.1093/ndt/gfs066

    Article  PubMed  Google Scholar 

  14. Truong LD, Krishnan B, Shen SS (2005) Intraoperative pathology consultation for kidney and urinary bladder specimens. Arch Pathol Lab Med 129(12):1585–1601. doi:10.1043/1543-2165(2005)129[1585:IPCFKA]2.0.CO;2

    PubMed  Google Scholar 

  15. Hagemann IS, Lewis JS Jr (2009) A retrospective comparison of 2 methods of intraoperative margin evaluation during partial nephrectomy. J Urol 181(2):500–505. doi:10.1016/j.juro.2008.10.020

    Article  PubMed  Google Scholar 

  16. Azancot MA, Moreso F, Salcedo M, Cantarell C, Perello M, Torres IB, Montero A, Trilla E, Sellares J, Morote J, Seron D (2014) The reproducibility and predictive value on outcome of renal biopsies from expanded criteria donors. Kidney Int 85(5):1161–1168. doi:10.1038/ki.2013.461

    Article  PubMed  Google Scholar 

  17. Wang HJ, Kjellstrand CM, Cockfield SM, Solez K (1998) On the influence of sample size on the prognostic accuracy and reproducibility of renal transplant biopsy. Nephrol Dial Transplant 13(1):165–172

    Article  CAS  PubMed  Google Scholar 

  18. Solez K, Colvin RB, Racusen LC, Haas M, Sis B, Mengel M, Halloran PF, Baldwin W, Banfi G, Collins AB, Cosio F, David DS, Drachenberg C, Einecke G, Fogo AB, Gibson IW, Glotz D, Iskandar SS, Kraus E, Lerut E, Mannon RB, Mihatsch M, Nankivell BJ, Nickeleit V, Papadimitriou JC, Randhawa P, Regele H, Renaudin K, Roberts I, Seron D, Smith RN, Valente M (2008) Banff 07 classification of renal allograft pathology: updates and future directions. Am J Transplant 8(4):753–760. doi:10.1111/j.1600-6143.2008.02159.x

    Article  CAS  PubMed  Google Scholar 

  19. Racusen LC, Solez K, Colvin RB, Bonsib SM, Castro MC, Cavallo T, Croker BP, Demetris AJ, Drachenberg CB, Fogo AB, Furness P, Gaber LW, Gibson IW, Glotz D, Goldberg JC, Grande J, Halloran PF, Hansen HE, Hartley B, Hayry PJ, Hill CM, Hoffman EO, Hunsicker LG, Lindblad AS, Yamaguchi Y et al (1999) The Banff 97 working classification of renal allograft pathology. Kidney Int 55(2):713–723

    Article  CAS  PubMed  Google Scholar 

  20. Racusen LC, Colvin RB, Solez K, Mihatsch MJ, Halloran PF, Campbell PM, Cecka MJ, Cosyns JP, Demetris AJ, Fishbein MC, Fogo A, Furness P, Gibson IW, Glotz D, Hayry P, Hunsickern L, Kashgarian M, Kerman R, Magil AJ, Montgomery R, Morozumi K, Nickeleit V, Randhawa P, Regele H, Seron D, Seshan S, Sund S, Trpkov K (2003) Antibody-mediated rejection criteria - an addition to the Banff 97 classification of renal allograft rejection. Am J Transplant 3(6):708–714

    Article  PubMed  Google Scholar 

  21. Haas M, Sis B, Racusen LC, Solez K, Glotz D, Colvin RB, Castro MC, David DS, David-Neto E, Bagnasco SM, Cendales LC, Cornell LD, Demetris AJ, Drachenberg CB, Farver CF, Farris AB 3rd, Gibson IW, Kraus E, Liapis H, Loupy A, Nickeleit V, Randhawa P, Rodriguez ER, Rush D, Smith RN, Tan CD, Wallace WD, Mengel M, as the Banff meeting report writing c (2014) Banff 2013 meeting report: inclusion of c4d-negative antibody-mediated rejection and antibody-associated arterial lesions. Am J Transplant 14(2):272–283. doi:10.1111/ajt.12590

    Article  CAS  PubMed  Google Scholar 

  22. Tervaert TW, Mooyaart AL, Amann K, Cohen AH, Cook HT, Drachenberg CB, Ferrario F, Fogo AB, Haas M, de Heer E, Joh K, Noel LH, Radhakrishnan J, Seshan SV, Bajema IM, Bruijn JA (2010) Pathologic classification of diabetic nephropathy. J Am Soc Nephrol 21(4):556–563. doi:10.1681/ASN.2010010010

    Article  PubMed  Google Scholar 

  23. Gaber LW, Moore LW, Alloway RR, Amiri MH, Vera SR, Gaber AO (1995) Glomerulosclerosis as a determinant of posttransplant function of older donor renal allografts. Transplantation 60(4):334–339

    Article  CAS  PubMed  Google Scholar 

  24. Randhawa PS, Minervini MI, Lombardero M, Duquesnoy R, Fung J, Shapiro R, Jordan M, Vivas C, Scantlebury V, Demetris A (2000) Biopsy of marginal donor kidneys: correlation of histologic findings with graft dysfunction. Transplantation 69(7):1352–1357

    Article  CAS  PubMed  Google Scholar 

  25. Cicciarelli J, Cho Y, Mateo R, El-Shahawy M, Iwaki Y, Selby R (2005) Renal biopsy donor group: the influence of glomerulosclerosis on transplant outcomes. Transplant Proc 37(2):712–713. doi:10.1016/j.transproceed.2004.12.108

    Article  CAS  PubMed  Google Scholar 

  26. Kayler LK, Mohanka R, Basu A, Shapiro R, Randhawa PS (2008) Correlation of histologic findings on preimplant biopsy with kidney graft survival. Transpl Int 21(9):892–898. doi:10.1111/j.1432-2277.2008.00681.x

    Article  PubMed  Google Scholar 

  27. Hofer J, Regele H, Bohmig GA, Gutjahr G, Kikic Z, Muhlbacher F, Kletzmayr J (2013) Pre-implant biopsy predicts outcome of single-kidney transplantation independent of clinical donor variables. Transplantation 97(4):426–432. doi:10.1097/01.tp.0000437428.12356.4a

    Article  Google Scholar 

  28. D'Agati V (2003) Pathologic classification of focal segmental glomerulosclerosis. Semin Nephrol 23(2):117–134

    Article  PubMed  Google Scholar 

  29. Karpinski J, Lajoie G, Cattran D, Fenton S, Zaltzman J, Cardella C, Cole E (1999) Outcome of kidney transplantation from high-risk donors is determined by both structure and function. Transplantation 67(8):1162–1167

    Article  CAS  PubMed  Google Scholar 

  30. Bosmans JL, Woestenburg A, Ysebaert DK, Chapelle T, Helbert MJ, Corthouts R, Jurgens A, Van Daele A, Van Marck EA, De Broe ME, Verpooten GA (2000) Fibrous intimal thickening at implantation as a risk factor for the outcome of cadaveric renal allografts. Transplantation 69(11):2388–2394

    Article  CAS  PubMed  Google Scholar 

  31. Woestenburg AT, Verpooten GA, Ysebaert DK, Van Marck EA, Verbeelen D, Bosmans JL (2009) Fibrous intimal thickening at implantation adversely affects long-term kidney allograft function. Transplantation 87(1):72–78. doi:10.1097/TP.0b013e31818bbe06

    Article  PubMed  Google Scholar 

  32. Wazna E, Pazik J, Perkowska-Ptasinska A, Lewandowski Z, Nazarewski S, Chmura A, Durlik M (2009) Arteriolar hyalinization in implantation kidney biopsies as a predictor of graft function. Transplant Proc 41(8):2975–2977. doi:10.1016/j.transproceed.2009.08.022

    Article  CAS  PubMed  Google Scholar 

  33. Hall IE, Reese PP, Weng FL, Schroppel B, Doshi MD, Hasz RD, Reitsma W, Goldstein MJ, Hong K, Parikh CR (2014) Preimplant histologic acute tubular necrosis and allograft outcomes. Clin J Am Soc Nephrol 9(3):573–582. doi:10.2215/CJN.08270813

    Article  PubMed  PubMed Central  Google Scholar 

  34. Mengel M, Sis B, Haas M, Colvin RB, Halloran PF, Racusen LC, Solez K, Cendales L, Demetris AJ, Drachenberg CB, Farver CF, Rodriguez ER, Wallace WD, Glotz D (2012) Banff 2011 meeting report: new concepts in antibody-mediated rejection. Am J Transplant 12(3):563–570. doi:10.1111/j.1600-6143.2011.03926.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors would like to thank all surgeons, nephrologists, pathologists, transplantation coordinators and laboratory technicians involved in the task of allocating and transplanting kidneys and discussing their experiences with us.

Authors’ contributions

PP, CS, IH and JUB: writing and discussion of the manuscript.

Author information

Authors and Affiliations

  1. Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany

    Przemyslav Pisarski

  2. German Organ Transplantation Foundation, Frankfurt, Germany

    Christina Schleicher

  3. Medical Clinic III, Nephrology, University Hospital Frankfurt, Frankfurt, Germany

    Ingeborg Hauser

  4. Institute of Pathology, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Jan U. Becker

Authors
  1. Przemyslav Pisarski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christina Schleicher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ingeborg Hauser
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan U. Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan U. Becker.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Additional information

Przemyslav Pisarski, Ingeborg Hauser and Jan U. Becker on behalf of the Kidney Committee of the Deutsche Transplantationsgesellschaft, Regensburg, Germany.

Jan U. Becker on behalf of the German Society of Pathology.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pisarski, P., Schleicher, C., Hauser, I. et al. German recommendations for pretransplantation donor kidney biopsies. Langenbecks Arch Surg 401, 133–140 (2016). https://doi.org/10.1007/s00423-016-1384-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-016-1384-5

Keywords

Search

Navigation