Evaluation of kidney procurement biopsy and machine perfusion on allograft outcomes: A retrospective cohort study of the Organ Procurement and Transplantation Network database.

Procurement biopsy and machine perfusion parameters can be utilized to assess donor kidney quality, but information may be incongruent. Using the Organ Procurement and Transplantation Network database from 2014 to 2022, we performed a retrospective cohort study of all adult recipients of solitary kidneys with a Kidney Donor Profile Index of 35% to 85%, which were biopsied and machine-perfused (N = 13 962). The biopsies were separated into "low" (≤10%), "intermediate" (11%-20%), and "high" (>20%) glomerulosclerosis (GS). The perfusion parameters were separated into "good" and "poor" based on a final resistance of 0.4 and a final flow rate of 100 mL/min. As GS and perfusion worsened, there were worsening trends for primary nonfunction, stage 4 chronic kidney disease at 1 year, and death-censored graft survival. In multivariable analyses, compared with their reference groups, high GS had a greater effect than poor perfusion on graft survival. Machine perfusion parameter thresholds appeared to delineate better-quality organs for kidneys with low and intermediate GS results. However, good perfusion may not distinguish outcomes in those with high GS. Despite this, allografts with high GS and poor perfusion still had a mean death-censored graft survival of 5.9 years. This information, together with careful donor-recipient matching, may assist in kidney utilization for the appropriate recipients.