Table 2.

Studies that assessed preimplant kidney biopsies for acute injury in relation to allograft or recipient outcomes

First AuthorYearCountryStudy TypeNBiopsy DetailsATN DefinitionShort-Term 
Recipient OutcomesLong-Term 
Recipient Outcomes
Goumenos (17)2010GreeceProspective, single center74Core biopsies done at recipient hospital; frozen and permanent sections compared; number of pathologists not specifiedATN reported as mild (affecting <25% of cortical area), moderate (25%–50%), or severe (>50%)Recipients with 3-month serum creatinine>2 mg/dl had (in retrospect) more severe ATNNot reported
Matignon (18)2008FranceRetrospective, single center172Wedge biopsies done at recipient hospital; permanent sections stained for H&E, PAS, Masson trichrome and silver; read by one pathologistNot clear, reported “presence of” ATN or osmotic nephrosisNeither ATN nor osmotic nephrosis was associated with DGFNot reported
Munivenkatappa (23)2008United StatesRetrospective, single center371Wedge biopsies done at procurement; frozen and permanent sections compared, stained for H&E and Masson trichrome; read by one pathologist, also used automatic morphometric analysisNot clear, ATN reported as “any”Not reportedATN was assessed as a potential variable for a score to predict graft failure, but it was not statistically significant and therefore not retained in the score
Oberbauer (19)1999AustriaRetrospective, single center92Wedge biopsies done at recipient hospital; permanent sections stained for H&E, PAS, silver, TUNEL, anti-PCNA and anti-bcl-2; number of pathologists not specifiedHistologic “acute tubular damage” scored from 0 to 3 (0, none; 1, mild; 2, moderate; 3, severe)Histologic acute tubular damage was not associated with DGF or rejection in the first 7 d; however, there was variably more TUNEL and bcl-2 positivity in kidneys with DGF or acute rejection compared with kidneys with immediate functionNot reported
Pokorná (20)2000Czech RepublicProspective, single center200Wedge biopsies done at procurement; permanent sections stained for H&E, PAS, silver, aniline fuchsin, and orange G; read by one pathologistTubular vacuolization and desquamation scored separately (0, absent; 1, mild; 2, moderate; 3, severe)Tubular vacuolization was associated with graft function at 1 wk, 3 wk, and 6 mo. Tubular desquamation was associated with graft function at 1 wk, 3 wk, and 3 moNeither injury type was significantly associated with graft function at 24 mo or with graft survival
Rohr (21)1983United StatesProspective, multicenter57Wedge biopsies done at procurement; permanent sections compared with repeat biopsy after cold storage at the recipient hospital; read by one pathologistGeneral histologic descriptions of tubule cell injury (e.g., luminal cytoplasmic debris, sloughing, vacuolization)Abnormalities consistent with acute injury were observed in 19 of 22 preimplant biopsies with DGF and 22 of 22 post-cold storage biopsies with DGFNot reported
Sulikowski (22)2010PolandRetrospective, single center92Core biopsies done “before kidney perfusion at mono- or multiorgan harvest”; permanent sections stained for H&E, PAS, silver, and Mallory; number of pathologists not specifiedNot clear, ATN reported as − (absent), +, or ++Absence of ATN was associated with immediate graft function. ATN was associated with DGF, PNF, and higher serum creatinine at 6 moATN was associated with higher serum urea at 1 and 3 yr, but was not associated with graft failure
  • Listed here are the results of a systematic search of the Cochrane and Medline databases for human studies of preimplant kidney biopsies for assessing early allograft injury in relation to allograft or recipient outcomes without date or language limitations. The following search terms were used: kidney, transplant, biopsy, donor, and preimplantation. A total of 30 publications were initially identified; 26 were excluded due to lack of histologic AKI reporting, animal studies, editorials, and 3 additional publications were identified by manual review of references. DGF, delayed graft function; H&E, hematoxylin and eosin; PAS, periodic acid–Schiff; PCNA, proliferating cell nuclear antigen; PNF, primary nonfunction; TUNEL, terminal deoxynucleotidyl transferase–mediated digoxigenin-deoxyuridine nick-end labeling.