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Macroscopic assessment of the quality of cold perfusion after deceased‐donor kidney procurement: A United Kingdom population‐based cohort study
Author(s) -
Dabare Dilan,
Hodson James,
Nath Jay,
Sharif Adnan,
Kalia Neena,
Inston Nicholas
Publication year - 2021
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.14272
Subject(s) - medicine , organ procurement , cohort , grading (engineering) , machine perfusion , renal function , population , urology , kappa , perfusion , surgery , transplantation , environmental health , linguistics , philosophy , civil engineering , engineering , liver transplantation
Abstract Concern regarding the quality of cold perfusion (QOP) during macroscopic assessment of procured kidneys is a common reason for discard. In the UK, QOP is routinely graded by both retrieving and implanting teams during back‐bench surgery as: 1 (good), 2 (fair), 3 (poor) or 4 (patchy). We evaluated the association of this grading with organ utilization, graft outcomes, and agreement between teams. Data on all deceased‐donor kidneys procured between January 2000 and December 2016 were analyzed for discard rates, while association with graft outcomes was studied in single adult transplants. Of 31,167 kidneys procured, 90.6%, 5.7%, 1.7%, and 2.1% were assigned grades 1, 2, 3, and 4, respectively, at retrieval. QOP was an independent risk factor of discard, with the highest rates observed in grade 3 kidneys (41.8%), compared to 6.5% in grade 1 (aOR 7.67, 95% CI 5.44–10.82, p < .001). Grading at retrieval was an independent predictor of delayed graft function ( p = .019) and primary non‐function ( p = .001), but not long‐term graft survival ( p = .111). Implanting grade was an independent predictor of all three outcomes ( p < .001, p < .001, and p = .002, respectively). Consistency of grading between teams was poor (Kappa = 0.179). QOP influences utilization and predicts outcomes, but a standardized and validated scoring system is required.