Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK.
Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Clin Transplant. 2021 May;35(5):e14272. doi: 10.1111/ctr.14272. Epub 2021 Mar 16.
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 utilization, graft outcomes, and agreement between teams. Data on all deceased-donor kidneys procured between January 2000 and December 2016 were analyzed for discard rates, while 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 < .001). Grading at retrieval was an independent predictor of delayed graft function (p = .019) and primary non-function (p = .001), but not long-term graft survival (p = .111). Implanting grade was an independent predictor of all three outcomes (p < .001, p < .001, and p = .002, respectively). Consistency of grading between teams was poor (Kappa = 0.179). QOP influences utilization and predicts outcomes, but a standardized and validated scoring system is required.
人们普遍担心获取的肾脏在宏观评估过程中的冷保存质量（QOP），这也是导致肾脏被丢弃的常见原因。在英国，QOP 通常由取肾和植肾团队在后台手术中进行分级：1（良好）、2（一般）、3（差）或 4（不均匀）。我们评估了这种分级与器官利用率、移植物结局以及团队之间的一致性之间的关系。对 2000 年 1 月至 2016 年 12 月期间获取的所有已故供体肾脏的数据进行了分析，以评估丢弃率，同时在单器官成人移植中研究了与移植物结局的关系。在获取的 31167 个肾脏中，分别有 90.6%、5.7%、1.7%和 2.1%的肾脏在获取时被分级为 1、2、3 和 4。QOP 是丢弃的独立危险因素，在 3 级肾脏中观察到的丢弃率最高（41.8%），而在 1 级肾脏中仅为 6.5%（优势比 7.67，95%置信区间 5.44-10.82，p<.001）。获取时的分级是延迟移植物功能（p=.019）和原发性无功能（p=.001）的独立预测因素，但不是长期移植物存活率的独立预测因素（p=.111）。植肾时的分级是所有三个结局的独立预测因素（p<.001、p<.001 和 p=.002，分别）。团队之间分级的一致性较差（Kappa=.179）。QOP 影响利用率并预测结局，但需要一个标准化和验证的评分系统。
