1. Defining Preimplantation Renal Allograft Quality Is biopsy: helpful or harmful? Michael J. Goldstein MD Director, Kidney/Pancreas Transplantation RMTI/Mount Sinai Medical Center

2. Strategies for Defining Preimplantation Renal Allograft Quality Donor demographics and history Donor renal function Medical management of the donor Renal anatomy Renal histology Machine perfusion characteristics

3. Strategies for Improving Organ Assessment - KDRI

5. Sixteen clinical trials involving 8,122 kidney transplants 6 were prospective studies. Strategies for Improving Organ Assessment - Biopsy

6. CONCLUSIONS Early graft outcome which may affect long-term outcomes, such as DGF and ATN, is associated more with abnormal IB histology. The relative impact of GS, IF, and arteriolar hyalinosis present in IB on long- term graft outcome remains limited to the extent that the prognostic information obtained from IB can be modified by other donor and recipient factors. Post-transplant biopsies are usually required to enhance the use of IB to predict the long-term outcomes. As such, no accurate single consistent proxy has so far been identified in the IB to accurately predict long-term graft outcome.

7. Strategies for Improving Organ Assessment - Biopsy

13. Sharing the Biopsy Results

14. Wedge biopsy technique

15. Core-Needle biopsy technique

16. Transplant Proc.Transplant Proc. 2010 Sep;42(7):2493-7.

17. Transplant Proc.Transplant Proc. 2010 Sep;42(7):2493-7.

20. Imported or undesirable kidney experience July 2005 to June 2006 107 patients transplanted with 117 imported kidneys

22. Strategies to Transplant More Kidneys Broaden acceptance criteria for GS

23. Biopsy Failures Differences in techniques Frozen section artifacts Experience and training of pathologist Lack of standardization of reports

24. 46yo man creat 1.4-2.0, CVA, no PMH

25. Machine Measured Renal Resistance

26. Strategies for Improving Organ Assessment – Renal Resistance and Biopsy

27. Predicted Probability Plots The ordinal regression demonstrates significance when scarring is 25-50% (p=0.02), no significance between MMRR and vascular narrowing, as well with glomerulosclerosis GlomerulosclerosisVascular NarrowingTubulointerstitial Scarring

28. Strategies for Improving Organ Assessment – Renal Resistance and Biopsy

32. Policy Creation

34. Conclusions Donor history, function, biopsy, and renal resistance are all interrelated All 4 are useful tools in defining donor renal allograft quality prior to transplantation The biopsy technique, processing, and the histologic report can lead to errors in reporting and interpretation of data. We should strive to have consistency in reporting by experienced renal pathologists Biopsy alone, with other favorable predictors, should be questioned before an organ is declined