Expanding Transplant Opportunities: Rethinking the Role of Offer Biopsy in Kidney Selection

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: Biopsy findings are a common refusal reason for deceased donor kidneys (DDKs) and some of these refused DDKs are then accepted and transplanted elsewhere, suggesting missed opportunities for transplant. We compared characteristics and outcomes of transplanted DDKs accepted vs. initially turned down for biopsy reasons by our program to assess the appropriateness of our acceptance criteria and identify adjustments needed to reduce missed opportunities. Methods: Retrospective analysis of OPTN data on DDKs offered by a regional OPO to a single center from 8/2022 to 8/2024. Only DDKs that were biopsied and ultimately transplanted were included. DDKs were classified as “kidney accepted (KA)” if accepted and transplanted by our program, or “kidney refused (KR)” if turned down by our program and transplanted elsewhere. DDKs refused for non-biopsy reasons were excluded. Donor and kidney characteristics and recipient outcomes were compared between the two groups. Outcomes of interest were rate of delayed graft function (DGF), recipient 6-month and 1-year serum creatinine (Se Cr), and 1-year graft survival (GS). Kaplan Meier (KM) survival analysis was performed with censoring date 8/16/24. Multivariate Cox regression of graft loss was performed on all variables across the entire cohort and within groups. Results: 103 DDKs were included, with 46 (44.7%) in the KA group, 57 (55.3%) in the KR group. KR kidneys had a higher degree of glomerulosclerosis and longer cold ischemia time. Other donor and kidney characteristics did not differ significantly between groups. Outcomes were similar between groups across all measures (Table 1). [Formula presented] No significant risk for graft loss were identified on multivariate analysis. Biopsied kidneys that were initially turned down (KR group) had a similar risk of failure as KA kidneys (HR 1.33, 95% CI [0.08 - 21.73], p=0.84). Conclusions: Despite differences in kidney characteristics, we found comparable allograft outcomes between KA and KR groups, reaffirming that biopsy findings should not be a consistent factor for refusal and indicating a need to adjust our donor exclusion criteria to reflect this understanding. CITATION INFORMATION: Lu Z., Patel A., Yoshida A. Expanding Transplant Opportunities: Rethinking the Role of Offer Biopsy in Kidney Selection AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: Z. Lu: None.

Volume

25

Issue

8

First Page

S375

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