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Histological and clinical evaluation of discarded kidneys in a European cohort of deceased brain death donor kidneys of marginal quality

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Abstract

Background

Despite organ shortages, the discard rate of deceased donor kidneys is high. Risk factors for this trend warrant further study.

Methods

We investigated reasons for discard in a cohort of brain death donors with marginal kidneys and procurement biopsies. Paraffin embedded procurement biopsies were systematically reevaluated and graded for the purpose of the study. Assessment included percentage of global glomerulosclerosis, Banff Lesion scores and tubular epithelial damage. Donor-, transplant process-, perfusion quality-, histopathology-, and recipient-related parameters were compared between discarded and transplanted organs.

Results

Although most clinical characteristics were similar between donors whose kidneys were transplanted and those whose kidneys were procured but discarded, discarded kidneys were more likely to be from donors with hepatitis C, to have undergone wedge biopsies, to show changes of acute and chronic injury and to be deemed poor quality. Except for obvious anatomic abnormalities, kidneys were often discarded due to the findings of procurement biopsies. Donors of kidneys discarded for histologic reasons more often had hypertension, coronary artery disease, stroke, and increased serum creatinine. The reason for discard was unknown in 20% of cases. Discarded kidneys came from donors who appeared to be clinically similar to donors whose kidneys were utilized for transplant.

Conclusion

A considerable proportion of discarded kidneys were of acceptable quality. The analysis of the outcome of every recovered organ could help to overcome this problem. Procurement biopsies more often lead to discard than to transplantation of recovered organs. Proper handling during allocation has to be determined.

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Data availability

Data discussed in this study are available on request by the corresponding author.

Abbreviations

ADQI:

Acute dialysis quality initiative

AKI:

Acute kidney injury

CMV:

Cytomegalovirus

DBDs:

Diseased brain death donors

DCDs:

Deceased cardiac death donors

ECDs:

Extended criteria donors

FSGS:

Focal segmental glomerulosclerosis

ICU:

Intensive care unit

IFTA:

Interstitial fibrosis and tubular atrophy

NC:

Nephrocalcinosis

TMA:

Thrombotic microangiopathy

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Acknowledgements

We would thank the following German transplant centers for providing us with recipient data for the present analysis: Transplantationszentrum Uniklinik RWTH Aachen; Transplantation Berlin-Charité-Universität Berlin; Transplantationszentrum Bochum; Transplantationszentrum-Universitätsklinikum Bonn; Dr. Frans Zantvoort, Klinikum Bremen Mitte; Transplantationszentrum Uniklinik Düsseldorf; Transplantationszentrum-Uniklinikum Essen; Prof. Dr. med. Martina Koch, Universitätsklinikum Hamburg-Eppendorf; Transplantationschirurgie-Uniklinik Innsbruck; Transplantationszentrum-Uniklinik Köln; PD Dr. med. Antje Habicht, Transplantationszentrum München der LMU-LMU Klinikum; Prof. Dr. med. Bernhard Banas, Universitäres Transplantationszentrum Regensburg; PD Dr. med. Martin Nitschke, Universitätsklinikum Schleswig-Holstein; Dr. Peter Weithofer, Transplantationszentrum Süd-Niedersachsen.

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Authors and Affiliations

  1. University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von Guericke University, Magdeburg, Germany

    Florian G. Scurt

  2. Deutsche Stiftung Organtransplantation (Region Baden-Württemberg), Stuttgart, Germany

    Carl-Ludwig Fischer-Fröhlich

  3. Otto-von Guericke University, Magdeburg, Germany

    Tamara Wassermann

  4. Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg Str. 1, 30655, Hannover, Germany

    Tamara Wassermann, Anke Schwarz & Christos Chatzikyrkou

  5. Institute of Medical Statistics and Bioinformatics, University of Cologne, Cologne, Germany

    Angela Ernst & Christos Chatzikyrkou

  6. Institute of Pathology, University Hospital of Cologne, Cologne, Germany

    Jan U. Becker

Authors
  1. Florian G. Scurt
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  2. Carl-Ludwig Fischer-Fröhlich
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  4. Angela Ernst
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  5. Anke Schwarz
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  6. Jan U. Becker
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  7. Christos Chatzikyrkou
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Contributions

CC and FGS conceived the study; JUB re-evaluated the biopsies; CC acquired recipient data; CLFF provided donor data on behalf of the DSO; CC wrote the manuscript; FGS created the tables and figures and performed the statistical analysis. TW participated in the acquisition of donor and recipient data. AE and AS provided intellectual input, reviewed, and edited the manuscript. All authors approved the final version of the revised manuscript.

Corresponding author

Correspondence to Christos Chatzikyrkou.

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Scurt, F.G., Fischer-Fröhlich, CL., Wassermann, T. et al. Histological and clinical evaluation of discarded kidneys in a European cohort of deceased brain death donor kidneys of marginal quality. J Nephrol 36, 2587–2600 (2023). https://doi.org/10.1007/s40620-023-01785-8

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