Does “the eye of the donor surgeon” predict kidney transplant outcome?
E. Tierie, J.I. Roodnat, F.J.M.F. Dor
Chair(s): dr. A. Nurmohamed
Thursday 9 march 2017
12:45 - 13:00h
Categories: Poster - Klinisch
Parallel session: Postersessie - Klinisch 2
Previously, we demonstrated that the retrieval surgeon’s subjective assessment of overall donor organ quality and perfusion best predicted the outcome of deceased donor kidney transplantation. In this study, we prospectively quantified the subjective impression of the donor surgeon to transplant outcomes.
Between 2014-2016, we performed a prospective regional pilot study for which a detailed organ assessment form was developed to be filled in by retrieval surgeons. Data scored were: temperature, kidney size, kidney perfusion, anatomical characteristics and abnormalities, atherosclerosis, degree of renal artery stenosis and overall quality of kidneys. Variables were scored categorically or on a 1-10 scale. Data on donor and recipient characteristics and graft function after transplantation were gathered. Correlations were made between organ assessment and graft function (immediate graft function (IGF) versus delayed graft function (DGF) or primary non-function (PNF)), and serum creatinine at 3 months post-transplantation.
In this study, 90 donors donated 178 kidneys of which 166 were transplanted (46.4% DBD, 53.6% DCD). The 12 discarded kidneys significantly more often were from DCD donors that were older, smoked, had lower BMI, lower quality parenchyma and acceptable perfusion from whom liver or pancreas were not retrieved. IGF was achieved in 55%, DGF in 35%, PNF in 4%, and unknown in 6% of the recipients. DGF/PNF occurred significantly more frequently in DCD kidneys (66% versus 49%, p=0.049), in donors with higher BMI (26.4±5.3 vs. 24.7±4.5, p=0.033), with less hypotensive episodes (10% vs. 29%, p=0.005), with lower perfusion quality (8.3±1.3 vs. 8.8±1.1, p=0.017), and larger kidneys (length: 11.8±1.6 vs. 11.1±1.3 cm, p=0.006, and width 6.1±0.9 vs. 5.8±0.9 cm, p=0.037), and in the presence of cysts (p=0.032) compared to IGF. The other variables were not significantly different between the groups. The data on serum creatinine at 3 months and 1 year after transplantation are incomplete and will be analysed in a later phase.
DGF/PNF after deceased donor kidney transplantation occurs more often in large kidneys that were poorly perfused as assessed by the donor surgeon. These kidneys would probably benefit most from reconditioning strategies, such as machine perfusion. A more precise scoring system might aid in decision-making towards acceptance, allocation, and potential reconditioning strategies.
