Macroscopic assessment of the quality of cold perfusion after deceased-donor kidney procurement: A United Kingdom population-based cohort study.

Dabare, Dilan, Hodson, James, Nath, Jay, Sharif, Adnan, Kalia, Neena and Inston, Nicholas (2021) Macroscopic assessment of the quality of cold perfusion after deceased-donor kidney procurement: A United Kingdom population-based cohort study. Clinical transplantation. e14272. ISSN 1399-0012.

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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 utilisation, graft outcomes and agreement between teams. Data on all deceased-donor kidneys procured between January 2000 and December 2016 were analysed for discard rates, whilst 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<0.001). Grading at retrieval was an independent predictor of delayed graft function (p=0.019) and primary non-function (p=0.001), but not long-term graft survival (p=0.111). Implanting grade was an independent predictor of all three outcomes (p<0.001, p<0.001 and p=0.002 respectively). Consistency of grading between teams was poor (Kappa=0.179). QOP influences utilisation and predicts outcomes, but a standardised and validated scoring system is required.

Item Type: Article
Subjects: WJ Urogenital system. Urology
Divisions: Emergency Services > Renal
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Depositing User: Mr Philip O'Reilly
Date Deposited: 10 Mar 2021 15:28
Last Modified: 10 Mar 2021 15:28
URI: http://www.repository.uhblibrary.co.uk/id/eprint/4067

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