Pre-implantation kidney biopsy: value of the expertise in determining histological score and comparison with the whole organ on a series of discarded kidneys.


Journal

Journal of nephrology
ISSN: 1724-6059
Titre abrégé: J Nephrol
Pays: Italy
ID NLM: 9012268

Informations de publication

Date de publication:
Feb 2020
Historique:
received: 06 06 2019
accepted: 10 08 2019
pubmed: 1 9 2019
medline: 8 6 2021
entrez: 1 9 2019
Statut: ppublish

Résumé

Evidence about the reliability of pre-implantation biopsy is still conflicting, depending on both biopsy type and pathologist's expertise. Aim of the study is to evaluate the agreement of general v specialist pathologists and to compare scores on biopsy and whole organs in a set of discarded kidneys. 46 discarded kidneys were identified with their corresponding biopsies. The biopsies were reviewed by three general and two specialist pathologists, blinded to the original report, according to Remuzzi score. The intraclass correlation coefficient (ICC) was calculated for both groups. Discarded kidneys were scored according to Remuzzi score by a single specialist pathologist. Biopsies and organs were compared by Wilcoxon signed rank test. Weighted κ coefficients between biopsy and organ scores were also calculated. Specialist pathologists achieved higher values of ICC, reaching excellent or good agreement in most of the parameters, while general pathologists values were mainly fair or good. On whole organs, scores were consistently lower than biopsies, with a significant difference in most of the parameters. Weighted κ coefficient was slight or fair for most of the parameters. Our data suggests that the creation of a pool of specialist pathologists would improve organ utilization. Moreover, biopsies are not representative of the whole organ. As the Remuzzi score on biopsy is a major reasons for discard, a quota of transplantable kidneys may be erroneously discarded. Refinement in Remuzzi cut-offs based on expert reporting and recognition of sampling error of biopsies in correlation with clinical outcome data should be undertaken.

Sections du résumé

BACKGROUND BACKGROUND
Evidence about the reliability of pre-implantation biopsy is still conflicting, depending on both biopsy type and pathologist's expertise. Aim of the study is to evaluate the agreement of general v specialist pathologists and to compare scores on biopsy and whole organs in a set of discarded kidneys.
METHODS METHODS
46 discarded kidneys were identified with their corresponding biopsies. The biopsies were reviewed by three general and two specialist pathologists, blinded to the original report, according to Remuzzi score. The intraclass correlation coefficient (ICC) was calculated for both groups. Discarded kidneys were scored according to Remuzzi score by a single specialist pathologist. Biopsies and organs were compared by Wilcoxon signed rank test. Weighted κ coefficients between biopsy and organ scores were also calculated.
RESULTS RESULTS
Specialist pathologists achieved higher values of ICC, reaching excellent or good agreement in most of the parameters, while general pathologists values were mainly fair or good. On whole organs, scores were consistently lower than biopsies, with a significant difference in most of the parameters. Weighted κ coefficient was slight or fair for most of the parameters.
CONCLUSIONS CONCLUSIONS
Our data suggests that the creation of a pool of specialist pathologists would improve organ utilization. Moreover, biopsies are not representative of the whole organ. As the Remuzzi score on biopsy is a major reasons for discard, a quota of transplantable kidneys may be erroneously discarded. Refinement in Remuzzi cut-offs based on expert reporting and recognition of sampling error of biopsies in correlation with clinical outcome data should be undertaken.

Identifiants

pubmed: 31471818
doi: 10.1007/s40620-019-00638-7
pii: 10.1007/s40620-019-00638-7
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

167-176

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Auteurs

Ilaria Girolami (I)

Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy.

Giovanni Gambaro (G)

Renal Unit, University and Hospital Trust of Verona, Verona, Italy.

Claudio Ghimenton (C)

Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy.

Serena Beccari (S)

Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy.

Anna Caliò (A)

Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy.

Matteo Brunelli (M)

Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy.

Luca Novelli (L)

Institute for Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy.

Ugo Boggi (U)

Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.

Daniela Campani (D)

Department of Pathology, University of Pisa, Pisa, Italy.

Gianluigi Zaza (G)

Renal Unit, University and Hospital Trust of Verona, Verona, Italy.

Luigino Boschiero (L)

Department of Surgical Sciences, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy.

José Ignacio López (JI)

Department of Pathology, Biocruces-Bizkaia Institute, Cruces University Hospital, University of the Basque Country (UPV/EHU), Barakaldo, Bizkaia, Spain.

Guido Martignoni (G)

Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy.
Pathology Unit, Pederzoli Hospital, Peschiera del Garda, Italy.

Antonia D'Errico (A)

Pathology Unit, S.Orsola-Malpighi University Hospital of Bologna, Bologna, Italy.

Dorry Segev (D)

Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Desley Neil (D)

Department of Histopathology, University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK.

Albino Eccher (A)

Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy. albino.eccher@aovr.veneto.it.

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