What are the benefits of frozen section biopsy of a kidney procured from a donor for transplantation?

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Last updated: April 18, 2025 • View editorial policy

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From the Guidelines

Frozen section biopsy of kidneys procured from deceased donors is crucial for evaluating organ quality and viability before implantation, allowing transplant teams to identify conditions that might affect graft function, as evidenced by the correlation between glomerulosclerosis and worse outcomes 1. The benefits of frozen section biopsy include assessing the percentage of globally sclerotic glomeruli and the extent of arteriosclerosis, which are directly linked to the quality of the section generated.

  • The easiest determination is quantitation of glomerulosclerosis, which is usually the main point of interest to the surgeon, and has been shown to be a predictor of outcome, with each increment in global sclerosis increasing the odds ratio for a worse outcome by 2.0 after correcting for recipient age 1.
  • The procedure involves taking a small wedge or needle biopsy from the kidney, which is then rapidly processed, stained, and examined microscopically within 20-30 minutes, minimizing cold ischemia time.
  • Frozen section biopsies help reduce the risk of primary non-function by identifying unsuitable organs before transplantation, expand the donor pool by allowing more accurate assessment of marginal organs, and improve allocation decisions by providing objective data on organ quality.
  • However, the technique has limitations, including sampling errors and lower resolution compared to permanent sections, and should be interpreted in context with other donor factors such as age, medical history, and terminal creatinine levels for optimal outcomes, as demonstrated by the importance of having at least 25 glomeruli in the baseline biopsy for a statistically significant prediction of outcome based on glomerulosclerosis 1.

From the Research

Benefits of Frozen Section Biopsy

  • The frozen section biopsy of kidney procured from donors can provide valuable information for rapid decision making in renal transplantation 2.
  • It allows for the evaluation of the kidney tissue within a short period, typically 2.5 hours, enabling clinicians to make informed decisions about the transplantation process 2.
  • The frozen section biopsy can help identify various conditions such as acute rejection, acute tubular necrosis, cyclosporine toxicity, chronic rejection, and infection 2.

Accuracy and Reliability

  • Studies have shown that frozen section biopsies have a high sensitivity and specificity in correlation with permanent sections, with sensitivity and specificity rates of 94.9% and 92.1%, respectively 3.
  • However, another study found that procurement biopsies, including frozen section biopsies, are poorly reproducible and do not correlate well with paraffin-embedded reperfusion biopsies, with an agreement rate of only 64% 4.
  • The use of deep learning models has been explored to improve the accuracy and reliability of frozen section biopsies, with promising results 5.

Prognostic Value

  • Frozen section preimplantation graft biopsy has been shown to have prognostic value in the outcome of renal transplantation, with the degree of glomerulosclerosis, acute tubular necrosis, and arteriolosclerosis correlated to renal function in the posttransplantation period 6.
  • The prognostic value of frozen section biopsies is comparable to that of regularly processed formalin-fixed biopsies, with no significant differences in the histological changes observed 6.
  • However, another study found that procurement biopsies, including frozen section biopsies, are not significantly associated with transplant outcomes, with reperfusion biopsies being more prognostic than procurement biopsies 4.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Research

Procurement Biopsies in the Evaluation of Deceased Donor Kidneys.

Clinical journal of the American Society of Nephrology : CJASN, 2018

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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