BACKGROUND: Donor kidney biopsies used for offer evaluation may lengthen cold ischemia time. Our organ procurement organization began processing wedge biopsies and having them read using virtual microscopy (VM), as opposed to its prior routine of processing/reading at local hospitals. We hypothesized that VM would decrease time to biopsy results and kidney acceptance.METHODS: All donor kidneys biopsied over 1 year were compared with those biopsied during the previous year (n = 43, 40).RESULTS: Time to biopsy result was shortened using VM (5:04 vs 6:30, P = .04), and especially for those cases with cross-clamp between 5 pm and 5 am (4:49 vs 8:12, P < .01). Time to local acceptance was also significantly improved using VM for both the entire group (7: 01 vs 9: 52, P < .01) and the overnight subset (7:25 vs 11:10, P < .01).CONCLUSIONS: Use of VM decreased time to biopsy result, with the most prominent effects seen during the overnight hours, resulting in shortened time to local acceptance of organs. (C) 2016 Elsevier Inc. All rights reserved.

Cardiovascular disease is the leading cause of death among those with renal insufficiency, those requiring dialysis, and in recipients of kidney transplants reflecting the greatly increased cardiovascular burden that these patients carry. The best method by which to assess cardiovascular risk in such patients is not well established. In the present study, 1,225 patients seeking a kidney transplant, over a 30-month period, underwent cardiovascular evaluation. Two hundred twenty-five patients, who met selected criteria, underwent coronary angiography that revealed significant coronary artery disease (CAD) in 47%. Those found to have significant disease underwent revascularization. Among the patients found to have significant CAD, 74% had undergone a nuclear stress test before angiography and 65% of these stress tests were negative for ischemia. The positive predictive value of a nuclear stress test in this patient population was 0.43 and the negative predictive value was 0.47. During a 30-month period, 28 patients who underwent coronary angiography received an allograft. None of these patients died, experienced a myocardial infarction, or lost their allograft. The annual mortality rate of those who remained on the waiting list was well below the national average. In conclusion, our results indicate that, in renal failure patients, noninvasive testing fails to detect the majority of significant CAD, that selected criteria may identify patients with a high likelihood of CAD, and that revascularization reduces mortality both for those on the waiting list and for those who receive an allograft. (C) 2016 Elsevier Inc. All rights reserved.

1 Hospital Universitario Fundación Santa Fe, Bogotá, Colombia 2 Department of Surgery, Division of Transplant, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 3 Department of Medicine, Division of Nephrology, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 4 Department of Pathology, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ