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Defining Preimplantation Renal Allograft Quality Is biopsy: helpful or harmful?

Defining Preimplantation Renal Allograft Quality Is biopsy: helpful or harmful?. Michael J. Goldstein MD Director, Kidney/Pancreas Transplantation RMTI/Mount Sinai Medical Center. Strategies for Defining Preimplantation Renal Allograft Quality . Donor demographics and history

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Defining Preimplantation Renal Allograft Quality Is biopsy: helpful or harmful?

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  1. Defining Preimplantation Renal Allograft QualityIs biopsy: helpful or harmful? Michael J. Goldstein MD Director, Kidney/Pancreas Transplantation RMTI/Mount Sinai Medical Center

  2. Strategies for Defining Preimplantation Renal Allograft Quality • Donor demographics and history • Donor renal function • Medical management of the donor • Renal anatomy • Renal histology • Machine perfusion characteristics

  3. Strategies for Improving Organ Assessment - KDRI

  4. Strategies for Improving Organ Assessment - Biopsy • Sixteen clinical trials • involving 8,122 kidney transplants • 6 were prospective studies.

  5. CONCLUSIONS • Early graft outcome which may affect long-term outcomes, such as DGF and ATN, is associated more with abnormal IB histology. • The relative impact of GS, IF, and arteriolar hyalinosis present in IB on long- term graft outcome remains limited to the extent that the prognostic information obtained from IB can be modified by other donor and recipient factors. Post-transplant biopsies are usually required to enhance the use of IB to predict the long-term outcomes. As such, no accurate single consistent proxy has so far been identified in the IB to accurately predict long-term graft outcome.

  6. Strategies for Improving Organ Assessment - Biopsy

  7. Strategies for Improving Organ Assessment - Biopsy

  8. Sharing the Biopsy Results

  9. Wedge biopsy technique

  10. Core-Needle biopsy technique

  11. Transplant Proc. 2010 Sep;42(7):2493-7.

  12. Transplant Proc. 2010 Sep;42(7):2493-7.

  13. Imported or “undesirable” kidney experience • July 2005 to June 2006 • 107 patients transplanted with 117 imported kidneys

  14. Strategies to Transplant More Kidneys • Broaden acceptance criteria for GS

  15. Biopsy Failures • Differences in techniques • Frozen section artifacts • Experience and training of pathologist • Lack of standardization of reports

  16. 46yo man creat 1.4-2.0, CVA, no PMH

  17. Machine Measured Renal Resistance

  18. Strategies for Improving Organ Assessment – Renal Resistance and Biopsy

  19. Glomerulosclerosis Tubulointerstitial Scarring Vascular Narrowing Predicted Probability Plots The ordinal regression demonstrates significance when scarring is 25-50% (p=0.02), no significance between MMRR and vascular narrowing, as well with glomerulosclerosis

  20. Strategies for Improving Organ Assessment – Renal Resistance and Biopsy

  21. Policy Creation

  22. Policy Creation

  23. Conclusions • Donor history, function, biopsy, and renal resistance are all interrelated • All 4 are useful tools in defining donor renal allograft quality prior to transplantation • The biopsy technique, processing, and the histologic report can lead to errors in reporting and interpretation of data. • We should strive to have consistency in reporting by experienced renal pathologists • Biopsy alone, with other favorable predictors, should be questioned before an organ is declined

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