Presentation Authors: 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, Juan Morote Robles, BARCELONA, Spain
Introduction: 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%). _x000D_
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 (&[kappa]=0,88) and atheroma in the ostium (&[kappa]=0,88) and moderate for RSR (&[kappa]=0,51). _x000D_
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.