Abdominal organ procurement in The Netherlands – An analysis of quality and clinical impact

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J.D. de Boer, W.H. Kopp, K.M. Ooms-de Vries, B.J.J.M. Haase-Kromwijk, C. Krikke, J. de Jonge, L.W.E. van Heurn, A.G. Baranski, J.A. van der Vliet, A Braat

Chair(s): dr. D.E. Braat & dr. N.C. van der Weerd

Thursday 9 march 2017

9:36 - 9:48h at Johan de Meesterzaal

Categories: Parallel - Klinisch

Parallel session: Parallelsessie XII – Klinisch 4 - Pretransplantatie en donatie

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In 2012 the quality form system was initiated to evaluate the quality of organ procurement in The Netherlands. In this study we analysed all completed quality forms from March 2012 till August 2013. Of all 754 accepted and shipped organs, 591 (78%) forms were filled out. These  included 133 livers (23%), 38 pancreata (6%) and 420 kidneys (71%). Response rate for each organ was 87% (133/153) livers, 90% (38/42) pancreata and 75% (420/559) kidneys.

In 133 cases (23%) there was a discrepancy between the data from the procuring and transplanting surgeons. Injuries were seen in 148 (25%) organs of which 12 (2%) led to discard of the organ; 1/133 (0.8%) livers, 5/38 (13%) pancreata and 6/420 (1.4%), kidneys (p<0.001). Higher donor BMI is a risk factor for procurement related injury in all organs (OR 1.06, 95% CI 1.01 – 1.11, p=0.011) and DCD donation in liver procurement (OR 2.31, p= 0.034). DCD donation is also associated with more pancreata being discarded due to injury (OR 10.333,  p=0.046). Furthermore, an association between a higher center procurement volume and less injuries is shown in the pancreata (OR= -0.95, p=0.013) and kidneys (OR=-0.91, p=0.012). Despite the relative high incidence of non-critical injuries there is no statistical significant difference in 1-year graft survival between (repaired) injured and intact organs for any organ.

In conclusion, the quality form system efficiently monitors the quality of organ procurement. Although there is a relatively high rate of organ injuries, the discard rate is low and it does not significantly affect 1-year graft survival for any organ. We identified higher BMI as a risk factor for injury in abdominal organs and DCD as a risk factor in livers. A higher procurement volume per center is associated with less injuries.