Donor Scoring System for Cadaveric Renal Transplantation

Abstract

We studied early renal function in 241 consecutive patients who received cadaveric renal transplants at two different transplantation centers (group 1, n = 90; group 2, n = 151). Univariate and multivariate analyses of data from group 1 showed a significant correlation between seven donor variables and early renal function after cadaveric renal transplantation. A scoring system was developed from these seven donor variables (cause of death, 0-6 points; history of hypertension, 0-6; final creatinine clearance before procurement, 0-6; age, 0-6; history of diabetes mellitus, 0-3; cold ischemia time, 0-3; and severity of renal artery plaque, 0-3). Data from group 2 were used to validate the donor scoring system and stratify cadaver kidneys on the basis of score: grade A, 0-5 points; grade B, 6-10; grade C, 11-15; and grade D, 16-32. A significant decline in early renal function was observed with increasing donor score and grade of cadaver kidney. In conclusion, a donor scoring system based on information available at the time of procurement can be used to estimate early graft function after cadaveric renal transplantation and may assist in the allocation of marginal organs.

Sirolimus Prolongs Recovery from Delayed Graft Function After Cadaveric Renal Transplantation

“…The mean and median ECD relative risk of the kidneys in our group was modest at 1.24 -0.29 and 1.14 ( Table 6); only nine kidneys (6.8%) met the definition of an ECD kidney. Similarly, the mean and median Novartis, Sangstat, and Nyberg scores for the transplants in our study are all quite modest ( (20), which they defined as the need for more than one hemodialysis treatment within 30 days of transplantation. Table 7 shows the outcome of Cox proportional hazards analysis of time to graft function using univariate models.…”

“…Two of the indices, Sangstat (18) and Novartis (19), were derived to identify transplant recipients at high risk of DGF. Finally, the Nyberg (20) scoring system was derived to identify transplant recipients at high risk for early graft dysfunction. All four indices were retrospectively derived; two of the indices (Novartis and Nyberg) have been prospectively validated.…”

Tubular Expression of KIM-1 Does not Predict Delayed Function After Transplantation

“…We found that renal fibrosis scores were weakly associated with the final creatinine clearance, supporting its implementation in some donor scoring systems. 32 Interestingly, we found that fibrosis positively correlated with KIM-1 scores, suggesting increased susceptibility of kidneys with fibrosis to ischemic injury. Our findings are in accordance with previous animal studies demonstrating that focal KIM-1 expression correlated with interstitial fibrosis and proliferation 33 ; therefore, KIM-1 may play an important role in the restoration of the morphologic integrity and function of the kidney.…”

Donor Quality Scoring Systems and Early Renal Function Measurements in Kidney Transplantation

“…On the other hand, the binary nature of the ECD definition may have underappreciated the variability of the quality of the organ. On these grounds, (Nyberg et al, 2001) a more granulated scoring system (deceased donor score, DDS) was developed. DDS was based on seven different donor variables easily available at the moment of procurement.…”