Histological assessment of pre-transplant kidney biopsies is reproducible and representative.

AIMS: Histological examination of pre-transplant renal biopsy specimens can be used to select grafts from older donors after cardiac death (DCD) with a satisfactory transplant outcome. The aim was to determine whether such biopsy specimens can be reproducibly scored between pathologists and are representative of the whole kidney. METHODS AND RESULTS: In renal biopsy specimens from DCD aged >or=60 years (n = 44), globally sclerosed glomeruli, vascular narrowing, tubular atrophy and interstitial fibrosis were scored by three independent pathologists according to the Pirani scoring system. Interobserver agreement on the sum of scores improved considerably with the introduction of a combined tubulo-interstitial scoring system (intraclass correlation coefficient increased from 0.38 to 0.64). In small needle biopsy specimens (n = 144) obtained at autopsy, estimates of the proportion of globally sclerosed glomeruli were more precise with increasing sample size. Reasonably precise estimates may be obtained from specimens with at least seven glomeruli. CONCLUSIONS: It is feasible to implement pre-transplant renal biopsy specimen analysis as a selection criterion in clinical practice in order to accept kidneys from marginal donors for transplantation.

Patent ductus venosus: problems in assessment and management.

A congenitally patent ductus venosus is the rarest form of portosystemic shunt. Although it occurs in the absence of serious parenchymal liver disease, it may be associated with hepatic encephalopathy. This case report describes a 49-year-old man with a patent ductus venosus who presented with recurrent bouts of encephalopathy but few other features of chronic liver disease. Ligation of the shunt was followed by life-threatening complications. The portal venous system must be carefully assessed before closure of a patent ductus venosus is attempted.