Renal Resistance Trend During Hypothermic Machine Perfusion Correlates With Preimplantation Biopsy Score in Transplantation of Kidneys From Extended Criteria Donors.

BACKGROUND: Graft quality from extended criteria donors (ECDs) is extremely wide, and a reliable evaluation parameter is required. So far, biopsy is widely used to evaluate ECD organs and to decide whether double (DKT) or single (SKT) kidney transplantation should be performed. The aim of this study is to compare renal resistance (RR) trend during hypothermic machine perfusion (HMP) with a preimplantation biopsy score. METHODS: From December 2014 to April 2020, HMP has been systematically applied to all organs from ECDs for at least 3 hours. All grafts underwent a preimplantation biopsy histologic assessment with Karpinski's score. SKTs or DKTs were performed accordingly. RR trend during the first 180 minutes of HMP was compared with the biopsy score. RESULTS: Eighty-three kidneys were used to perform 57 transplantations (31 SKTs and 26 DKTs). A biopsy confirmed suitability for transplantation in all cases, and the median score was 4 (range, 2-7). Kidneys with a score of 5 to 7 had significantly higher RR value than kidneys with a score of 0 to 4 at basal time (3.35 vs 2.71; P = .074), at 60 minutes (1.24 vs 0.94; P = .031), at 120 minutes (1.10 vs 0.81; P = .010), and at 180 minutes (1.00 vs 0.77; P = .022). A cutoff value of RR ≥0.88 at 120 minutes of perfusion had the best sensibility and specificity (0.71 and 0.75, respectively) to discriminate kidneys with a score of 5 to 7 from kidneys with a score of 0 to 4. No differences were found in postoperative outcomes between SKT and DKT recipients. CONCLUSIONS: RR trend during HMP correlates with the histologic score in ECD kidneys and can be used as a reliable parameter to evaluate graft quality.

Underestimated risk of cancer in solitary thyroid nodules ≥3 cm reported as benign.

BACKGROUND: The study aims to assess the risk of cancer in solitary thyroid nodules ≥30 mm in size reported as Bethesda II, and its implications. METHOD: The clinical records of 202 patients, who underwent thyroid lobectomy for solitary nodules measuring ≥30 mm, reported as Bethesda II on preoperative FNAC between Jan 2015 and Apr 2016 were reviewed. Data collected included nodule size and consistency, and final histopathology results. The risk of cancer and the recommended management according to ATA guidelines were the outcomes of interest. Comparisons were then made between two size categories: (30-40 mm; n = 72; C1) and (>40 mm; n = 130; C2), and two nodule consistencies. RESULTS: Mean nodule size was 43.2 mm (range 30-92). Ninety-five percent were solid and 5% were predominantly cystic. The risk of cancer was 22.8% (46/202) with no size threshold, or graded increase in risk observed. Based on biologic behavior, 50% of cancers were considered clinically significant. Accordingly, the risk of cancer for which surgery is recommended was 11.4% (23/202). The risk of cancer requiring total thyroidectomy was 9.4% and was influenced by nodule size (19 vs. 60% in C1 and C2, respectively; p = 0.01). Predominantly cystic nodules had a greater risk of malignancy compared to predominantly solid nodules even after adjusting for size (40 vs. 9.9%; p = 0.01 and 40 vs. 12.5%; p = 0.02, respectively). CONCLUSION: The risk of malignancy in Bethesda II solitary nodules ≥30 mm is considerable implying a need for changing the way these are approached and refining cytopathology reporting.