Preimplantation Histological Score Associates with 6-Month GFR in Recipients of Perfused, Older Kidney Grafts: Results from a Pilot Study

Outcomes of Dual Kidney Transplants from High KDPI Kidneys are Superior Compared to Single Kidney High KDPI Transplants at One-Year

Dual kidney transplantation (DKT), utilizing two adult kidneys from the same donor for one recipient, has been used as way to expand the available donor pool. These kidneys often come from high Kidney Donor Profile Index donors (KDPI >85%). Data comparing outcomes between high KDPI DKT and single kidney transplants (SKT) remain limited. We assessed outcomes of 336 high KDPI kidney transplants performed at our center; 11.0% (n = 37) were DKT. Recipients of DKT were older (p = 0.02) and donors had a higher KDPI score (median 96% vs. 91%, p<0.0001). DKT operative time was higher compared to SKT (+1.4 hours, p<0.0001). There were no differences in delayed graft function (54.1% vs. 51.5%, p = 0.77) and hospital length of stay (median 4.0 vs. 3.0 days, p = 0.21) between DKT and SKT. Grade I Clavien-Dindo complications occurred in 8.1% of DKT and 13.7% of SKT (p = 0.008). There were no grade IVa, IVb or V complications in either group. DKT had more glomerulosclerosis (p = 0.04), interstitial fibrosis (p = 0.02), tubular atrophy (p = 0.01), and arterial thickening (p = 0.03) on one-year protocol biopsies. Estimated glomerular filtration was higher for DKT at one- (p = 0.004) and two-years post-transplant (p = 0.01). There were no differences in patient (HR 1.3, 95% CI 0.5-3.3, p = 0.58) or graft (HR 1.1, 95% CI 0.5-2.3, p = 0.83) survival. Good outcomes can be achieved with DKT using high KDPI kidneys with moderate chronic changes. DKT is a good option to help further utilize high KDPI kidneys and minimize discard. This article is protected by copyright. All rights reserved.

Advantages of Using a Web-based Digital Platform for Kidney Preimplantation Biopsies

Background:

In the setting of kidney transplantation, histopathology of kidney biopsies is a key element in the organ assessment and allocation. Despite the broad diffusion of the Remuzzi–Karpinski score on preimplantation kidney biopsies, scientific evidence of its correlation to the transplantation outcome is controversial. The main issues affecting the prognostic value of histopathology are the referral to general on-call pathologists and the semiquantitative feature of the score, which can raise issues of interpretation. Digital pathology has shown very reliable and effective in the oncological diagnosis and treatment; however, the spread of such technologies is lagging behind in the field of transplantation. The aim of our study was to create a digital online platform where whole-slide images (WSI) of preimplantation kidney biopsies could be uploaded and stored.

Methods:

We included 210 kidney biopsies collected between January 2015 and December 2019 from the joint collaboration of the transplantation centers of Padua and Verona. The selected slides, stained with hematoxylin and eosin, were digitized and uploaded on a shared web platform. For each case, the on-call pathologists' Remuzzi grades were obtained from the original report, together with the clinical data and the posttransplantation follow-up.

Results:

The storage of WSI of preimplantation kidney biopsies would have several clinical, scientific, and educational advantages. The clinical utility relies on the possibility to consult online expert pathologists and real-time quality checks of diagnosis. From the perspective of follow-up, the archived digitized biopsies can offer a useful comparison to posttransplantation biopsies. In addition, the digital online platform is a precious tool for multidisciplinary meetings aimed both at the clinical discussion and at the design of research projects. Furthermore, this archive of readily available WSI is an important educational resource for the training of professionals.

Conclusions:

Finally, the web platform lays the foundation for the introduction of artificial intelligence in the field of transplantation that would help create new diagnostic algorithms and tools with the final aim of increasing the precision of organ assessment and its predictive value for transplant outcome.