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The Prognostic Value of Renal Resistance During Hypothermic Machine Perfusion of Deceased Donor Kidneys
Author(s) -
Jochmans I.,
Moers C.,
Smits J. M.,
Leuvenink H. G. D.,
Treckmann J.,
Paul A.,
Rahmel A.,
Squifflet JP.,
van Heurn E.,
Monbaliu D.,
Ploeg R. J.,
Pirenne J.
Publication year - 2011
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2011.03685.x
Subject(s) - machine perfusion , medicine , relative risk , hazard ratio , prospective cohort study , transplantation , vascular resistance , cohort , perfusion , surgery , proportional hazards model , cardiology , confidence interval , liver transplantation , hemodynamics
Vascular renal resistance (RR) during hypothermic machine perfusion (HMP) is frequently used in kidney graft quality assessment. However, the association between RR and outcome has never been prospectively validated. Prospectively collected RR values of 302 machine‐perfused deceased donor kidneys of all types (standard and extended criteria donor kidneys and kidneys donated after cardiac death), transplanted without prior knowledge of these RR values, were studied. In this cohort, we determined the association between RR and delayed graft function (DGF) and 1‐year graft survival. The RR (mmHg/mL/min) at the end of HMP was an independent risk factor for DGF (odds ratio 21.12 [1.03–435.0]; p = 0.048) but the predictive value of RR was low, reflected by a c‐statistic of the receiver operator characteristic curve of 0.58. The RR was also found to be an independent risk factor for 1‐year graft failure (hazard ratio 12.33 [1.11–136.85]; p = 0.004). Determinants of transplant outcome are multifactorial in nature and this study identifies RR as an additional parameter to take into account when evaluating graft quality and estimating the likelihood of successful outcome. However, RR as a stand‐alone quality assessment tool cannot be used to predict outcome with sufficient precision.