TABLE 1.
List of all PICOs and recommendations.
| PICO | Recommendation | Quality of evidence | Strength of recommendation |
|---|---|---|---|
| 1. For evaluating chronic lesions in ECD kidneys (P), is the needle core biopsy (I) comparable/inferior/superior to wedge biopsy (C) or punch biopsies in terms of representatively of the entire renal parenchyma (O)? | For the evaluation of chronic lesions in ECD kidneys, needle core and wedge biopsy are both suitable, even though differences may be found in terms of glomerular and vascular assessment. Punch biopsies have potentially similar suitability, although more evidence is required | Moderate (B) | Strong for (1) |
| 2. For the evaluation of chronic lesions in ECD kidneys (P), is the frozen section (I) comparable/inferior/superior to paraffin embedded section (C) in terms of reliability of the reading from pathologists? | For the evaluation of chronic lesions in ECD kidneys the frozen section is inferior to paraffin embedded section in terms of reliability of the reading from pathologists. Frozen sections should not be considered as a first option; however, it could be suitable for use in selected cases such as clinical urgency or other specific contexts | Moderate (B) | Weak against (2) |
| 3. For score assessment of pre-implantation kidney biopsy in the evaluation of ECD (P) is the experienced renal pathologist (I) comparable/inferior/superior to on-call pathologist (C) in terms of reproducibility and accuracy of the histological report (O)? | For score assessment of pre-implantation kidney biopsy in the evaluation of ECD the experienced renal pathologist is superior to non-experienced pathologist in terms of reproducibility and accuracy for the prediction of total parenchyma status | High (A) | Strong for (1) |
| 4. In the quantification of chronic damage in ECD kidneys (P), is glomerulosclerosis (I) more reproducible (O) in comparison with other parameters (interstitial fibrosis, tubular atrophy, wall/lumen ratio, arteriolar hyalinosis) (C)? | In the quantification of the chronic damage in ECD kidneys, glomerulosclerosis is more reproducible in comparison with other parameters (interstitial fibrosis, tubular atrophy, wall/lumen ratio, arteriolar hyalinosis) | Low (C) | Weak for (2) |
| 5. In the quantification of the chronic damage in ECD kidneys (P) is measurement of histological variables with digital pathology (I) comparable/inferior/superior (O) when compared with light microscopy (C)? | In the quantification of the chronic damage in ECD kidneys measurement of histological variables with digital pathology is potentially comparable with light microscopy | High (A) | Strong for (1) |
| 6. In the quantification of the chronic damage in ECD kidneys (P) is measurement of histological variables with the aid of special stainings (Periodic-Acid Schiff, Silver, Picro Sirius Red, Trichrome stainings) (I) comparable/inferior/superior (O) if compared with Haematoxylin and Eosin alone (C)? | In the quantification of chronic damage in ECD kidneys, the use of additional histochemical stainings (including, but not limited to PAS, Silver, Trichrome and/or Picro Sirius Red) is superior to the use of H&E alone in any diagnostic kidney pathology context but can likely not be performed under time constraints in the context of (on-call) organ utilization decision making | Low (C) | Strong for (1) (expert-opinion) |
| 7. In the quantification of the chronic damage in ECD kidneys (P), is glomerulosclerosis percentage (I) more representative than other parameters (interstitial fibrosis, tubular atrophy, arteriolar hyalinosis and cv score) (C) to predict the graft survival, graft function, primary non-function (O)? | Even though no studies are available for head-to-head comparison between GS and the other parameters, the degree of GS in procurement kidney biopsies from ECDs is associated with graft survival | Moderate (B) | Strong for (1) |