Too many donor kidneys are discarded in U.S. earlier than transplantation

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When kidneys are removed from deceased organ donors in the United States, they are often subjected to “procurement biopsies” and discarded when certain abnormalities appear in kidney tissue – a practice that exacerbates the already severe shortage of transplantable kidneys in the country. According to a new study by a team led by researchers from the Perelman School of Medicine at the University of Pennsylvania and the Paris Translational Research Center on Organ Transplantation, a large portion of discarded kidneys would function acceptably in a transplant.

In the study, published today in the Journal of the American Society of Nephrology, researchers analyzed biopsy data from a number of 1,103 kidneys discarded in the United States between 2015 and 2016. They found that 493 of these kidneys could match on biopsy-assessed quality and other donor characteristics for 493 kidneys that were actually transplanted in France, where transplant practice is less restrictive.

The researchers then examined the performance of these 493 kidneys transplanted in France and found that their survival rates were acceptable – 93 percent at one year, 81 percent at five years, and 69 percent at 10 years – suggesting that many donor kidneys were in the USA lives are unnecessarily discarded.

When analyzing a larger set of kidney transplants in France for which biopsy data were available, the researchers concluded that the biopsy data was of no value in more accurately predicting graft failure.

“These results underscore a missed transplant opportunity in the US and provide a strong rationale for organ procurement organizations to reduce the practice of collecting deceased donor kidney biopsies,” said study director Peter Reese, MD, MSCE, Associate Professor of Renal Electrolyte & Hypertension and Epidemiology from the University of Pennsylvania’s Perelman School of Medicine and a kidney transplant physician at Penn Transplant Center.

The study was a collaboration with several medical centers in the US, France, and Belgium led by Dr. med. Olivier Aubert was jointly managed. and corresponding author Dr. med. Alexandre Loupy from the Paris Translational Research Center for Organ Transplantation.

The shortage of kidneys for transplant remains a public health crisis in the US. More than 90,000 patients await kidney transplants, but only about 20,000 transplants are performed each year. Annually, nearly 5,000 people on the transplant waiting list die without receiving a transplant.

Deceased donors provide approximately two-thirds of the transplanted kidneys, but thousands of kidneys from deceased donors are discarded annually in the US due to anomalies in procurement biopsies. Studies suggest that most discards are due to significant glomerulosclerosis, which can be caused by age or diabetes, and involves scarring of small blood vessels in the kidney. However, research also suggests that the reproducibility of the procurement biopsy results is poor.

In addition, in several European countries, kidney transplants are usually performed without procurement biopsies and are therefore less likely to be discarded. A study published last year by the same research team found that French transplant centers are much more likely to accept kidneys from older deceased donors than US centers. In fact, the average age of deceased French donors is more than 15 years older than that of deceased kidney donors in the United States

The results of this new study underscore the assumption that pre-transplant biopsies do not appear to add value to the kidney transplant process and, in fact, tend to make the situation worse by reducing kidney supplies that could benefit recipients.

“Transplant center staff should understand that the procurement biopsy results provide limited meaningful information about kidney quality,” Reese said. “In some cases, these biopsies can add bad information. And unfortunately, these biopsies come at a cost – in terms of delays, costs, and the occasional complication.”

The procedure for determining the suitability of donor kidneys for transplantation may be in error

More information:
Journal of the American Society of Nephrology (2020). DOI: 10.1681 / ASN.2020040464 Provided by the Perelman School of Medicine at the University of Pennsylvania

Quote: In the US, too many donor kidneys are discarded prior to transplantation (2020, December 15), which was found on December 15, 2020 from were retrieved

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