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

Ilaria Girolami, Giovanni Gambaro, Claudio Ghimenton, Serena Beccari, Anna Caliò, Matteo Brunelli, Luca Novelli, Ugo Boggi, Daniela Campani, Gianluigi Zaza, Luigino Boschiero, José Ignacio López, Guido Martignoni, Antonia D’Errico, Dorry Segev, Desley Neil, Albino Eccher

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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: 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: 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: 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.

Original languageEnglish (US)
Pages (from-to)167-176
Number of pages10
JournalJournal of Nephrology
Issue number1
StatePublished - Feb 1 2020


  • Agreement
  • Biopsy score
  • Donor biopsy
  • Pre-implantation biopsy
  • Transplantation

ASJC Scopus subject areas

  • Nephrology


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