Kate O'Mahony

Kate O’Mahony is a general medicine advanced trainee, currently working as a rheumatology registrar in Middlemore Hospital in Auckland. She obtained her medical degree from Bristol University and after completing her house officer years in Manchester, immigrated to New Zealand just over 3 years ago.​

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Are Procurement Renal Biopsies Essential For Older Deceased Donors?

Aims: Do procurement renal biopsies performed for donor age ≥55years affect graft usage?
Is there a correlation between the Kidney Donor Profile Index (KDPI) and the histological New Zealand Chronic Kidney Disease Score (NZCKS)?

Methods: Subjects were all deceased donor kidneys procured for transplantation between 01.01.2015 and 19.07.2019 in donors ≥55years. Donor past medical history was reviewed for biopsy indications. KDPI scores were calculated and compared with the NZCKS. Pearson’s coefficient was calculated for correlation of KDPI and NZCKS.

Results: 172 kidneys from 86 donors, with 13 not transplanted and 20 dual transplants. In donors 55-65.9years, no biopsies performed for age altered kidney usage. In donors> 66years, in 2 (of 5) not transplanted and 10 (of 12) dual transplants, biopsies performed for age affected graft usage. Pearson’s coefficient showed r=0.2385 (p=0.0017), a weakly positive correlation.

Conclusions: In New Zealand, procurement biopsies are required for those either ≥55years, with hypertension, diabetes or chronic kidney disease1,2. Their predictive utility is unclear3,4. Internationally, procurement biopsies are not routine, often reserved for ≥60years and some instead use KDPI scores5.
In deceased donors aged 55-65.9years, with no other renal-related co-morbidities, there is no need to perform a routine procurement biopsy. From this research the National Renal Transplant Leadership Team changed their guidelines so that procurement biopsies are only routinely performed on deceased donors aged over 65years. The KDPI is a poor predictor of NZCKS.

References: 
1 ANZDATA. Transplanting Hospital Report https://www.anzdata.org.au/report/transplanting-hospital- report-2012-2017/
2 Organ Donation New Zealand. Annual Report 2017
3 Wang, Wetmore, Crary. The donor kidney biopsy and its implications in predicting graft outcomes: a systematic review. American Journal of Transplantation.2015;15:1903–1914
4 Carpenter, Husain, Brennan. Procurement Biopsies in the Evaluation of Deceased Donor Kidneys. CJASN.2018;13(12):1876-1885
5 Baskin-Bey, Kremers, Stegall. United Network for Organ Sharing’s expanded criteria donors: is stratification useful? Clinical Transplantation.2005;19(3):406–41