The Banff working group on preimplantation biopsy was established to develop consensus criteria (best practice guidelines) for the interpretation of preimplantation kidney biopsies. Digitally scanned slides were used (i) to evaluate interobserver variability of histopathologic findings, comparing frozen sections with formalin-fixed, paraffin-embedded tissue of wedge and needle core biopsies, and (ii) to correlate consensus histopathologic findings with graft outcome in a cohort of biopsies from international medical centers. Intraclass correlations (ICCs) and univariable and multivariable statistical analyses were performed. Good to fair reproducibility was observed in semiquantitative scores for percentage of glomerulosclerosis, arterial intimal fibrosis and interstitial fibrosis on frozen wedge biopsies. Evaluation of frozen wedge and core biopsies was comparable for number of glomeruli, but needle biopsies showed worse ICCs for glomerulosclerosis, interstitial fibrosis and tubular atrophy. A consensus evaluation form is provided to help standardize the reporting of histopathologic lesions in donor biopsies. It should be recognized that histologic parameters may not correlate with graft outcome in studies based on organs deemed to be acceptable after careful clinical assessment. Significant limitations remain in the assessment of implantation biopsies.

Cedars Sinai Medical Center Department of Pathology and Lab Medicine Los Angeles CA

Department of Pathology and Immunology Washington University School of Medicine St Louis MO

Department of Pathology and Internal Medicine Johns Hopkins University Hospital Baltimore MD

Department of Pathology Cornell University New York NY

Department of Pathology University of Alberta Alberta Canada

Department of Pathology University of Pittsburgh Thomas E Starzl Transplant Institute Pittsburgh PA

Department of Pharmacy Barnes Jewish Hospital Saint Louis MO

Emory University Hospital Atlanta GA

IKEM Prague Czech Republic

INCUCAI Buenos Aires Argentina

Mayo Clinic Scottsdale AZ

Nephropath Little Rock AR

Piedmont Hospital Atlanta GA

Santa Casa de Misericordia de Porto Alegre Hospital and Universidade Federal de Ciências da Saúde de Porto Alegre Rio Grande do Sul Brazil

Transplantation Institute Medical University of Warsaw Warsaw Poland

University of Sao Paulo Renal Transplant Service Sao Paulo Brazil

See more in PubMed

Israni AK, Salkowski N, Gustafson S, et al. New national allocation policy for deceased donor kidneys in the United States and possible effect on patient outcomes. J Am Soc Nephrol 2014; 25: 1842–1848. PubMed PMC

OPTN/SRTR report 2008. Table 3.2. Available from: http://www.ustransplant.org.

Policy 3.5: Organ Distribution: Allocation of deceased kidneys 6/20/2008. Policy 3.5.9.2: desirable information for kidney offers. Available from: http://optn.transplant.hrsa.gov/PoliciesandBylaws.

Racusen LC, Solez K, Colvin RB, et al. The Banff 97 working classification of renal allograft pathology. Kidney Int 1999; 55: 713–723. PubMed

Solez K, Colvin RB, Racusen LC, et al. Banff 07 classification of renal allograft pathology: Updates and future directions. Am J Transplant 2008; 8: 753–760. PubMed

Shrout PE, Fleiss JL. Intraclass correlations: Uses in assessing rater reliability. Psychol Bull 1979; 86: 420–428. PubMed

Cockfield SM, Moore RB, Todd G, Solez K, Gourishankar S. The prognostic utility of deceased donor implantation biopsy in determining function and graft survival after kidney transplantation. Transplantation 2010; 89: 559–566. PubMed

Duman S, Ozbek S, Sen S, et al. Is “zero‐hour” biopsy of the transplanted kidney risky? Transplant Proc 2004; 36: 137–138. PubMed

Ekser B, Rigotti P. Transplantation: Can a single criterion determine the use of ECD kidneys? Nat Rev Nephrol 2010; 6: 68–70. PubMed

Escofet X, Osman H, Griffiths DF, Woydag S, Adam Jurewicz W. The presence of glomerular sclerosis at time zero has a significant impact on function after cadaveric renal transplantation. Transplantation 2003; 75: 344–346. PubMed

Gaber LW, Moore LW, Alloway RR, Amiri MH, Vera SR, Gaber AO. Glomerulosclerosis as a determinant of posttransplant function of older donor renal allografts. Transplantation 1995; 60: 334–339. PubMed

Randhawa P. Role of donor kidney biopsies in renal transplantation. Transplantation 2001; 71: 1361–1365. PubMed

Randhawa PS, Minervini MI, Lombardero M, et al. Biopsy of marginal donor kidneys: Correlation of histologic findings with graft dysfunction. Transplantation 2000; 69: 1352–1357. PubMed

Remuzzi G, Cravedi P, Perna A, et al. Long‐term outcome of renal transplantation from older donors. N Engl J Med 2006; 354: 343–352. PubMed

Pokorna E, Vitko S, Chadimova M, Schuck O. Adverse effect of donor arteriolosclerosis on graft outcome after renal transplantation. Nephrol Dial Transplant 2000; 15: 705–710. PubMed

Munivenkatappa RB, Schweitzer EJ, Papadimitriou JC, et al. The Maryland aggregate pathology index: A deceased donor kidney biopsy scoring system for predicting graft failure. Am J Transplant 2008; 8: 2316–2324. PubMed

Snoeijs MG, Winkens B, Heemskerk MB, et al. Kidney transplantation from donors after cardiac death: A 25‐year experience. Transplantation 2010; 90: 1106–1112. PubMed

Wang CJ, Wetmore JB, Crary GS, Kasiske BL. The donor kidney biopsy and its implications in predicting graft outcomes: A systematic review. Am J Transplant 2015; 15: 1903–1914. PubMed

Lu AD, Desai D, Myers BD, Dafoe DC, Alfrey EJ. Severe glomerular sclerosis is not associated with poor outcome after kidney transplantation. Am J Surg 2000; 180: 470–474. PubMed

Mazzucco G, Magnani C, Fortunato M, Todesco A, Monga G. The reliability of pre‐transplant donor renal biopsies (PTDB) in predicting the kidney state. A comparative single‐center study on 154 un‐transplanted kidneys. Nephrol Dial Transplant 2010; 25: 3401–3408. PubMed

Bosmans JL, Woestenburg A, Ysebaert DK, et al. Fibrous intimal thickening at implantation as a risk factor for the outcome of cadaveric renal allografts. Transplantation 2000; 69: 2388–2394. PubMed

Sood P, Randhawa PS, Mehta R, Hariharan S, Tevar AD. Donor kidney microthrombi and outcomes of kidney transplant: A single‐center experience. Clin Transplant 2015; 29: 434–438. PubMed

Reese PP, Hall IE, Weng FL, et al. Associations between deceased donor urine injury biomarkers and kidney transplant allografts. J Am Soc Nephrol 2016; 27: 1534–1543. PubMed PMC

Shapiro R, Halloran PF, Delmonico FL, Bromberg JS. The “two, one, zero” decision: What to do with suboptimal deceased donor kidneys. Am J Transplant 2010; 10: 1959–1960. PubMed

Sung RS, Christensen LL, Leichtman AB, et al. Determinants of discard of expanded criteria donor kidneys: Impact of biopsy and machine perfusion. Am J Transplant 2008; 8: 783–792. PubMed

Tan JC, Workeneh B, Busque S, Blouch K, Derby G, Myers BD. Glomerular function, structure, and number in renal allografts from older deceased donors. J Am Soc Nephrol 2009; 20: 181–188. PubMed PMC

Yushkov Y, Dikman S, Alvarez‐Casas J, Giudice A, Hoffman A, Goldstein MJ. Optimized technique in needle biopsy protocol shown to be of greater sensitivity and accuracy compared to wedge biopsy. Transplant Proc 2010; 42: 2493. PubMed

Azancot MA, Moreso F, Salcedo M, et al. The reproducibility and predictive value on outcome of renal biopsies from expanded criteria donors. Kidney Int 2014; 85: 1161–1168. PubMed

Haas M, Segev DL, Racusen LC, et al. Arteriosclerosis in kidneys from healthy live donors: Comparison of wedge and needle core perioperative biopsies. Arch Pathol Lab Med 2008; 132: 37–42. PubMed

Neil DA, Demetris AJ. Digital pathology services in acute surgical situations. Br J Surg 2014; 101: 1185–1186. PubMed

Sasaki K, Randhawa P, Demetris AJ, et al. Diagnostic discrepancies between frozen and permanent section diagnoses in pretransplant donor kidney biopsies. Quality assurance study of 1887 cases. Lab Invest 2010; 90(Suppl 1): Meeting abstract 1540: 345A–346A.

Delphi: A Democratic and Cost-Effective Method of Consensus Generation in Transplantation