A Re-evaluation of Discarded Deceased Donor Kidneys in the UK

Mittal, Shruti; Adamusiak, Anna; Horsfield, Catherine; Loukopoulos, Ioannis; Karydis, Nikolaos; Kessaris, Nicos; Drage, Martin; Olsburgh, Jonathon; Watson, Chris; Callaghan, Chris

doi:10.1097/tp.0000000000001542

Cited by 35 publications

(46 citation statements)

References 18 publications

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“…The choice of an independent consultant at the same center to compare test performance was pragmatic, but also served as the strictest possible control, as many confounding factors such as local policy or “surgical culture” would be shared. Despite this, and in keeping with what others have reported, surgeons—in this case, even from the same center—do not always agree on whether a given kidney is suitable for transplant, further buttressing the case for an objective method of interrogating these differences of opinion …”

Section: Discussionsupporting

confidence: 44%

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Development of an objective, standardized tool for surgical assessment of deceased donor kidneys: The Cambridge Kidney Assessment Tool

Ayorinde

Hamed

Goh

et al. 2020

Clinical Transplantation

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Quality assessment in kidney transplantation involves inspection to identify negative markers of organ quality. However, there is a paucity of evidence guiding surgical appraisal, and currently there is no evidence to differentiate important features from those that can be safely ignored. We propose a method to standardize surgical assessment and derived a simple rule to rapidly identify kidneys suitable for transplantation. Donor and recipient data were recorded alongside clinical outcomes in a prospectively maintained database. We developed a proforma (Cambridge Kidney Assessment Tool, CKAT) and used it to assess deceased donor kidney transplants. Factors predictive of utilization were identified by multivariate and univariate logistic regression analysis of CKAT‐assessment scores, and test performance was evaluated using standard 2 × 2 contingency tables. Ninety‐seven kidneys were included at a single center (2013‐2014), and 184 CKAT assessments were performed. A CKAT threshold of “Carrell + Perfusion >3” was highly specific (99%) and performed favorably to consultant opinion (specificity 95%). 96% of the kidneys implanted in accordance with the rule survived to 1 year (mean eGFR 45.3 mL/min/1.73 m2). To our knowledge, this is the first attempt to objectively define macroscopic features that are relevant to kidney utilization. Common language could support training in organ assessment and ultimately help address unnecessary discard of donor kidneys.

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Section: Discussionsupporting

confidence: 44%

“…Despite this, and in keeping with what others have reported, surgeonsin this case, even from the same center-do not always agree on whether a given kidney is suitable for transplant, further buttressing the case for an objective method of interrogating these differences of opinion. 2,22 TA B L E 2 A 2 × 2 contingency…”

Section: Appraisal Rulementioning

confidence: 99%

Development of an objective, standardized tool for surgical assessment of deceased donor kidneys: The Cambridge Kidney Assessment Tool

Ayorinde

Hamed

Goh

et al. 2020

Clinical Transplantation

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“…This has cost implications, as there is a significant financial benefit associated with a patient receiving a transplant as opposed to continuing dialysis . Furthermore, although kidney transplants from DCD donors have equivalent graft survival to those from donation after brain death (DBD) donors in the United Kingdom, transplants from DCD donors have a much higher rate of delayed graft function (DGF), and a higher rate of organ discard …”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the Cambridge group has reported the use of EVNP in successfully transplanting human kidneys that were deemed untransplantable and declined by all UK transplant units . EVNP may therefore be able to reduce the rate of deceased donor kidneys that are unnecessarily discarded . However, EVNP is a technically complex procedure, and reports have been published from only 2 groups to date .…”

Section: Introductionmentioning

confidence: 99%

“…2 Furthermore, although kidney transplants from DCD donors have equivalent graft survival to those from donation after brain death (DBD) donors in the United Kingdom, [3][4][5] transplants from DCD donors have a much higher rate of delayed graft function (DGF), and a higher rate of organ discard. 6 Warm organ perfusion technologies such as ex vivo normothermic perfusion (EVNP) may be able to successfully address some of these concerns. EVNP is a technique using pediatric cardiopulmonary bypass technology enabling the perfusion of an organ with a warm, oxygenated, erythrocytebased solution prior to transplantation.…”

Section: Introductionmentioning

confidence: 99%

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Dissemination of a novel organ perfusion technique: ex vivo normothermic perfusion of deceased donor kidneys

et al. 2019

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Ex vivo normothermic perfusion (EVNP) technology is a promising means of organ preservation, assessment, and preconditioning prior to kidney transplantation, which has been pioneered by a single group. We describe the challenges of setting up clinical EVNP programs in 2 new centers, as well as early patient outcomes. Governance, training, and logistical pathways are described. In order to demonstrate safety and proficiency in this new technique, early patient outcomes are also described. Patient outcomes included the incidence of primary nonfunction, delayed graft function, graft and patient survival at 1 year. Contralateral kidneys undergoing static cold storage alone were used as a comparator group. Between March 2016 and July 2017, EVNP was performed on 14 kidneys from 12 donors (11 kidneys in center 1, 3 kidneys in center 2). Of the 14 kidneys that underwent EVNP, 12 organs were implanted into 10 recipients. Two pairs of kidneys were implanted as dual grafts and 1 kidney was implanted simultaneously with a pancreas. The remaining 7 kidneys were transplanted as single allografts. Seven pairs of kidneys were available for paired analysis comparing EVNP versus static cold storage. Graft and patient outcomes were comparable between the 2 preservation techniques. The introduction of a clinical EVNP service requires a careful multimodal approach, drawing on the expertise of specialists in transplantation, hematology, and microbiology. Both new clinical EVNP programs demonstrated proficiency and safety when a structured dissemination process was followed.

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Distinct global DNA methylation and NF-κB expression profile of preimplantation biopsies from ideal and non-ideal kidneys

et al. 2022

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A Re-evaluation of Discarded Deceased Donor Kidneys in the UK

Abstract: The KFTS scheme is successfully identifying organs at high risk of discard, though potentially transplantable organs are still being discarded. Analyses of discarded organs are essential to identify barriers to organ utilization and develop strategies to reduce unnecessary discard.

Cited by 35 publications

References 18 publications

Development of an objective, standardized tool for surgical assessment of deceased donor kidneys: The Cambridge Kidney Assessment Tool

Development of an objective, standardized tool for surgical assessment of deceased donor kidneys: The Cambridge Kidney Assessment Tool

Dissemination of a novel organ perfusion technique: ex vivo normothermic perfusion of deceased donor kidneys

Distinct global DNA methylation and NF-κB expression profile of preimplantation biopsies from ideal and non-ideal kidneys

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