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Are wedge biopsies of cadaveric kidneys obtained at procurement reliable?

Authors :
Muruve NA
Steinbecker KM
Luger AM
Source :
Transplantation [Transplantation] 2000 Jun 15; Vol. 69 (11), pp. 2384-8.
Publication Year :
2000

Abstract

Background: Single wedge biopsy of cadaveric kidneys from donors older than 55 is currently the standard method of evaluating their viability for transplantation. The degree of glomerulosclerosis presently determines whether a kidney can be transplanted, but most biopsies sample only the subcapsular region and may not accurately represent the true renal architecture. Our study evaluated the accuracy of transplant suitability determinations based upon the single wedge biopsy of cadaveric kidneys.<br />Methods: We took kidneys that were refused by UNOS centers on the basis of biopsy results, examined their histology in detail, and reviewed donor medical histories. Sections were taken from the upper, lower, and mid-portion of each kidney and stained with the periodic acid Schiff stain. Percentage and location of glomerulosclerosis and other relevant pathology were then determined in each section. We compared our findings with the results of the original wedge biopsies obtained at the time of procurement.<br />Results: Nine kidneys were obtained and examined. The wedge biopsies at the time of procurement showed glomerulosclerosis ranging from 8 to 36% (median 17%). The multiple kidney sections we analyzed showed fewer sclerosed glomeruli, ranging from 3 to 15% (median 7%, P<0.001), with most of the sclerosed glomeruli identified located in the immediate subcapsular region (P<0.001).<br />Conclusions: Wedge biopsies of donor kidneys can overestimate the total amount of glomerulosclerosis, apparently because of a predominance of sclerosis in the kidney's subcapsular region, the area predominantly sampled by the usual wedge biopsy. These inappropriately high estimates of glomerulosclerosis can result in refusal of kidneys that might be suitable for transplantation.

Details

Language :
English
ISSN :
0041-1337
Volume :
69
Issue :
11
Database :
MEDLINE
Journal :
Transplantation
Publication Type :
Academic Journal
Accession number :
10868645
Full Text :
https://doi.org/10.1097/00007890-200006150-00029