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Discarding Donor Kidneys: Are Resources Being Unnecessarily Wasted?

Discarding Donor Kidneys: Are Resources Being Unnecessarily Wasted?

Mohan, S., Campenot, E., Chiles, M.C., Santoriello, D., Bland, E., Crew, R.J., ... Markowitz, G. (2017). Association between reperfusion renal allograft biopsy findings and transplant outcomes. Journal of the American Society of Nephrology, 28, 3109-3117. doi:10.1681/ASN. 2016121330

Mohan and colleagues (2017) explored the number of deceased donor kidneys discarded due to biopsy findings, the most common reason for discard, to determine the number of kidneys that might be appropriate for transplantation. Their focus was to investigate and compare transplant function with pre-transplant histologic findings to renal function post-transplant to try to determine if the two were linked. Experienced renal pathologists evaluated histologic findings on biopsies obtained post perfusion in kidneys from both donors who were deceased and those who were living. The outcomes from donors who were older or who had diabetes mellitus, hypertension, and obesity with a higher kidney donor risk index (KDPI) consistently had suboptimal function, regardless of donor source. (Note: the KDPI is only performed on donors who are deceased, not living donors.) Kidneys from living donors were consistently superior to deceased donor kidneys, regardless of the histologic findings. Interestingly, those kidneys from deceased donors with suboptimal histologic findings were functional five years post-transplantation. Moreover, even with suboptimal histology, transplants from live donors had notably better outcomes than kidneys from deceased donors with optimal histologic findings. These findings were borne out with multivariate analysis for both donors and recipients (e.g., HLA mismatch, donors who were hypertensive, recipients with diabetes).

Pre-transplant biopsies appeared to inadvertently overestimate the degree of renal parenchymal scarring that led to an underestimation of the quality of the kidney once transplanted. Recipients of kidneys from deceased donors with optimal histology had superior function, 81.7%, to those with sub-optimal histology, 73.2%, five years post-transplant. The authors suggest that discarding over a third of the kidneys from deceased donors based upon histologic findings is not always severe enough to warrant that action and may be based upon other donor factors. They also conclude there is limited value of histologic findings for the recipients of living donor kidneys when compared to the outcomes of the recipients of deceased donor kidneys. As noted above, even though there is a difference between optimal and sub-optimal histology for deceased donors, the potential still exists for reasonable intermediate and longer term outcomes.

The authors focused on the most common basis for deceased donor kidneys being discarded, and their findings suggest there may be kidneys not being made available for transplantation based upon somewhat erroneous information (i.e., sub-optimal biopsy results prior to transplantation may yield acceptable outcomes). Their question and pursuit are important, given the number of people awaiting transplantation and the possible discarding of organs that may prove viable.

Karen C. Robbins, Department Editor

Karen C. Robbins, MS, RN, CNN, is the Associate Editor of the Nephrology Nursing Journal, Past-President of ANNA, and member of ANNA's Desert Vista Chapter.

The NNJ Journal Club Department provides information on publications and resources of value to nephrology nurses. Please submit ideas for Journal Club topics and recommendations for articles that might be included in future Journal Club departments to karenrobbins.nnj@gmail.com.
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Title Annotation:NNJ Journal Club: Read It, Share It
Author:Robbins, Karen C.
Publication:Nephrology Nursing Journal
Date:Nov 1, 2017
Words:535
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