Minerva Urology and Nephrology 2021 Apr 22

DOI: 10.23736/S2724-6051.21.04345-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Surgeon preimplantation macroscopic graft appraisal improves risk stratification of deceased kidney donors: a prospective study

Enric MIRET ¹ ✉, Francesc MORESO ², Nestor TOAPANTA ², David LORENTE ¹, Marina TRIQUELL ¹, Teresa PONT ³, Santiago PÉREZ-HOYOS ⁴, Daniel SERÓN ², Juan MOROTE ¹, Enrique TRILLA ¹

¹ Department of Urology and kidney transplantation, Vall d’Hebrón Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain; ² Department of Nephrology and kidney transplantation, Vall d’Hebrón Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain; ³ Transplant Coordination, Vall d’Hebrón Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain; ⁴ Unit of Statistics and Bioinformatics, Vall d’Hebrón Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain

BACKGROUND: Preimplantation scores assist with correct kidney graft allocation, but macroscopic graft features have never been evaluated in this scenario.
METHODS: We designed a graft appraisal questionnaire, assessed its reproducibility by comparing the senior and junior surgeon responses and evaluated which features can predict transplant outcomes in 202 patients transplanted from 144 donors at a tertiary centre. We created new prediction models in combination with validated preimplantation scores. The primary outcome was graft loss or eGFR<30ml/min/1.73m2 at six months and secondary outcomes were delayed graft function, early graft loss and graft function at six months.
RESULTS: Interrater correlation was very good for adherent perinephric fat (kappa=0.91) and acceptable for cortical surface roughness (kappa=0.51) and cortical colour (kappa=0.47). Adherent perirrenal fat (Odds ratio=4.77; 95% Confidence interval=2.10-10.85) and surface roughness (OR=2.11, 95% CI=1.25-3.58) were independent predictors of the primary outcome, improving the kidney donor risk index efficacy model (AUC 0.71 vs 0.82 p=<0.001), while cortical colour and adherent fat improved the Irish risk model for delayed graft function (AUC 0.76 vs 0.82, p=0.03). We created nomograms to visually assess the risk of both endpoints.
CONCLUSIONS: kidney graft macroscopic appraisal is reproducible between surgeons and can improve the accuracy of clinical preimplantational prediction scores.

KEY WORDS: Kidney transplantation; Pathological Conditions, Anatomical; Donor selection