MACROSCOPIC APPRAISAL OF KIDNEY GRAFTS AND ITS ASSOCIATION WITH DELAYED GRAFT FUNCTION

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II (MP70)1 Apr 2019MP70-20 MACROSCOPIC APPRAISAL OF KIDNEY GRAFTS AND ITS ASSOCIATION WITH DELAYED GRAFT FUNCTION Enric Miret Alomar*, Enrique Trilla Herrera, Francesc Moreso Mateos, Nestor Toapanta Gaibor, Mercè Cuadras Solé, Aina Salazar Gabarró, Oriol Moreno Ribera, Lucas Regis Plácido, David Lorente Garcia, Teresa Pont Castellana, Daniel Serón Micas, and Juan Morote Robles Enric Miret Alomar*Enric Miret Alomar* More articles by this author , Enrique Trilla HerreraEnrique Trilla Herrera More articles by this author , Francesc Moreso MateosFrancesc Moreso Mateos More articles by this author , Nestor Toapanta GaiborNestor Toapanta Gaibor More articles by this author , Mercè Cuadras SoléMercè Cuadras Solé More articles by this author , Aina Salazar GabarróAina Salazar Gabarró More articles by this author , Oriol Moreno RiberaOriol Moreno Ribera More articles by this author , Lucas Regis PlácidoLucas Regis Plácido More articles by this author , David Lorente GarciaDavid Lorente Garcia More articles by this author , Teresa Pont CastellanaTeresa Pont Castellana More articles by this author , Daniel Serón MicasDaniel Serón Micas More articles by this author , and Juan Morote RoblesJuan Morote Robles More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557112.46608.0eAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: The prediction of kidney graft function can broaden the offer of kidneys and improve the survival of the receptors compared with dialysis. A macroscopic evaluation is always performed by transplant surgeons, but there is a lack of reports correlating the particular characteristics of the grafts and their functionality. Our aim is to evaluate whether macroscopic appraisal of the grafts is associated with the delayed graft function (DGF), and thus becoming an adjunct tool with a validated predicting model like the Irish Risk Score (IRS). METHODS: We performed a prospective evaluation of 102 consecutive kidneys transplanted between June 2016 and October 2017 from deceased donors in our center. The first and second surgeons evaluated, during the bench surgery, the renal surface roughness (RSR), the perinephric fat adherence (PFA), infarcts, scars, anatomy variants and atheroma in the vessels. We collected information from the donors and recipients in order to calculate the Irish Score for DGF. The endpoints were: Primary non-function (PNF, absence of perfusion of the kidney diagnosed in the first control after transplant) and DGF (need for dialysis treatment during the first week after surgery). Kappa index was calculated for the macroscopic variables to test interrater reliability. RESULTS: PNF was observed in 4 cases (3,9%) and DGF in 19 cases of the 98 functioning kidneys (19,4%). The presence of atheroma in the ostium was associated with PNF (RR 29,7; 95% CI 2,8-316), but 9 on 12 grafts (75%) displaying atheroma showed primary function. In the univariate analysis, DGF showed an association with IRS, atheroma in the ostium, RSR and PFA. In the multivariate analysis, the Irish Risk Score (p=0,0007), SR (p=0.0119) and PFA (p=0,0196) were associated with DGF. The reproducibility of macroscopic variables was very good for PFA (κ=0,88) and atheroma in the ostium (κ=0,88) and moderate for RSR (κ=0,51). We designed a risk score for DGF taking into account the Irish Risk Score and macroscopic data. We evaluated by the ROC analysis the c-statistic of both scores: AUC_Irish_Score=0.80 (95% CI:0.69-0.91) and AUC_Irish+Macroscopy_Score=0.85 (95% CI:0.76-0.93), which supposes an increase in the prediction of the new model on the verge of clinical significance (p=0.0708). CONCLUSIONS: The Irish Risk Score is a validated model for predicting DGF and our data are in agreement with them. RSR and PFA are reproducible variables and independently associated with DGF even when the model is adjusted by the Irish risk score. Our data needs to be correlated with a validation cohort to confirm our results. Source of Funding: none Barcelona, Spain© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1045-e1046 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Enric Miret Alomar* More articles by this author Enrique Trilla Herrera More articles by this author Francesc Moreso Mateos More articles by this author Nestor Toapanta Gaibor More articles by this author Mercè Cuadras Solé More articles by this author Aina Salazar Gabarró More articles by this author Oriol Moreno Ribera More articles by this author Lucas Regis Plácido More articles by this author David Lorente Garcia More articles by this author Teresa Pont Castellana More articles by this author Daniel Serón Micas More articles by this author Juan Morote Robles More articles by this author Expand All Advertisement PDF downloadLoading ...