A study led by researchers at Columbia University Irving Medical Center have made an important discovery about the way donated kidneys are assessed before transplantation, that could call into question current decision-making processes about whether an organ can be used or not.
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Researchers looking at biopsy samples taken from deceased donor kidneys, found that the results of initial biopsies often differed to those from repeat biopsies.
Although initial biopsy results were not associated with patient outcomes post-transplant, the results of repeat biopsies, were and did provide valuable information about how the organ might function.
The results suggest that initial kidney biopsy results may not be reliable for assessing organ quality before transplantation unless new standards are established for how the procedure is performed and how the results are interpreted.
Kidneys in health and disease
Kidneys filter blood to remove excess waste and water from the body in the form of urine, as well as maintaining the balance of bodily fluids and returning filtered, purified blood to the body.
In cases of kidney disease, the organ fails to filter blood and remove toxic waste, accumulating in the body. This can cause a range of complications including fatigue, hypertension, headaches, seizures, and anemia. Kidney disease can also increase a person’s risk of heart disease, diabetes, and stroke. The condition can be treated if it is detected during the early stages of the disease, but in severe cases, patients often require a transplant to survive.
Kidney disease statistics
According to the National Institute of Diabetes and Digestive and Kidney Diseases, approximately 14% of individuals in the United States have kidney disease; 661,000 have kidney failure; 468,000 are on dialysis and about 193,000 are living with a transplanted kidney.
More than 100,000 people are on the U.S national waiting list for a kidney transplant and more than 3,000 patients are added each month. Some people can wait for as long as ten years for a transplant, while others only wait for a few, depending on blood type, the patient’s health and the availability of organs.
There is a significant shortage of donated kidneys
Currently, a significant shortage of donated kidneys means only 16,000 people per year receive a transplant and 13 people die waiting for a kidney every single day.
The most common way that kidneys are donated is through a deceased donor, and in 2018, 10,722 patients received deceased kidney donor transplants.
Despite the shortage of donated kidneys, one in every five kidneys recovered for transplantation is not used, mainly due to concerns about the organ’s quality that arise as a result of biopsy findings.
To establish whether a kidney is fit for transplantation, clinicians often examine a biopsy under a microscope. However, previous studies assessing the reliability of these biopsy findings have generated mixed results.
To investigate, a research team led by S. Ali Husain and Sumit Mohan from Columbia University Irving Medical Center assessed 606 kidneys, for which both an initial and a repeat biopsy had been taken.
Results differed between the two biopsies
As reported in the Clinical Journal of the American Society of Nephrology, results often differed between the two biopsies.
Only the results of repeat biopsies provided useful information about kidney quality that was associated with how well the organ functioned following transplantation.
The team also reports that the majority of first biopsies were carried out at other organ procurement organizations, whereas almost all second biopsies were performed and interpreted at investigators' local organ procurement organization.
"These findings suggest that current decision-making about kidney quality may often be based on misleading information, but that standardizing biopsy techniques may result in more helpful biopsies," Husain concludes.