Introduction:The global prevalence of end-stage renal disease (ESRD) continues to rise, exacerbating the shortage of donor kidneys and leading to increased mortality and medical expenses among patients awaiting transplantation. Expanded criteria donor (ECD) kidneys are vital for alleviating organ shortages; however, traditional donor kidney biopsies are usually performed intraoperatively, resulting in delays and unnecessary resource utilization. This study investigates an innovative strategy of performing pre-procurement renal biopsies in the ICU to optimize donor kidney quality assessment and minimize resource expenditure.
Method:We retrospectively analyzed nine cases from June 2024 to June 2025 at the Jiangsu Organ Procurement Organization, wherein pre-procurement renal biopsies were conducted in the ICU. All potential donors were confirmed brain-dead, and explicit consent for donation and biopsy was obtained from family members. A multidisciplinary team consisting of nephrologists, intensivists, and ultrasonologists performed bedside ultrasound-guided renal biopsies in the ICU. Biopsy specimens underwent rapid paraffin-embedded processing with Hematoxylin and Eosin (HE) and Periodic Acid-Schiff (PAS) staining. Pathological evaluation was conducted by two experienced renal pathologists using the internationally recognized Remuzzi scoring system.
Results:No complications, including bleeding, infection, or organ damage, occurred during any of the nine ICU biopsies, confirming procedural safety. Pathological findings included varying degrees of glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriolar sclerosis. Pathology results directly informed decisions regarding kidney utilization: kidneys from seven donors (14 kidneys) were deemed suitable for transplantation, while two donors were excluded from donation due to severe interstitial lesions. All 14 transplanted kidneys regained function without primary non-function, although eight recipients experienced delayed graft function (DGF); however, renal function fully recovered before discharge.
Conclusion:This study demonstrates for the first time the feasibility and safety of performing pre-procurement renal biopsies in the ICU. This innovative approach significantly enhances the accuracy and timeliness of pathological evaluations, effectively preventing unnecessary procedures due to poor-quality kidneys and greatly optimizing medical resource allocation. Given its clinical effectiveness, this strategy holds promise for international implementation, offering a novel solution to the global challenge of organ shortages.