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Development of an objective, standardized tool for surgical assessment of deceased donor kidneys: The Cambridge Kidney Assessment Tool
Author(s) -
Ayorinde John O. O.,
Hamed Mazin,
Goh Mingzheng Aaron,
Summers Dominic M.,
Dare Anna,
Chen Yining,
SaebParsy Kourosh
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13782
Subject(s) - medicine , contingency table , kidney , logistic regression , transplantation , kidney transplantation , univariate , univariate analysis , gold standard (test) , multivariate analysis , surgery , intensive care medicine , multivariate statistics , statistics , mathematics
Quality assessment in kidney transplantation involves inspection to identify negative markers of organ quality. However, there is a paucity of evidence guiding surgical appraisal, and currently there is no evidence to differentiate important features from those that can be safely ignored. We propose a method to standardize surgical assessment and derived a simple rule to rapidly identify kidneys suitable for transplantation. Donor and recipient data were recorded alongside clinical outcomes in a prospectively maintained database. We developed a proforma (Cambridge Kidney Assessment Tool, CKAT) and used it to assess deceased donor kidney transplants. Factors predictive of utilization were identified by multivariate and univariate logistic regression analysis of CKAT‐assessment scores, and test performance was evaluated using standard 2 × 2 contingency tables. Ninety‐seven kidneys were included at a single center (2013‐2014), and 184 CKAT assessments were performed. A CKAT threshold of “Carrell + Perfusion >3” was highly specific (99%) and performed favorably to consultant opinion (specificity 95%). 96% of the kidneys implanted in accordance with the rule survived to 1 year (mean eGFR 45.3 mL/min/1.73 m 2 ). To our knowledge, this is the first attempt to objectively define macroscopic features that are relevant to kidney utilization. Common language could support training in organ assessment and ultimately help address unnecessary discard of donor kidneys.