演題情報

学会・委員会企画

開催回
第56回・2011年・横浜
 

Scoring System for Machine-Preserved Marginal Deceased-Donor Kidneys for Single and Double Kidney Transplantation

演題番号 : GI-P-2

Junichiro Sageshima:1、Gaetano Ciancio:1、Linda Chen:1、George W. Burke III:1

1:The Lillian Jean Kaplan Renal Transplant Center, Division of Kidney and Pancreas Transplantation, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States

 

To establish a scoring system for kidney transplantation (KTx) from marginal donors, we retrospectively analyzed 92 patients who received KTx from expanded criteria donors (ECD) and donation after cardiac death (DCD). All kidneys were preserved by machine perfusion and histologically evaluated before KTx. The kidneys were transplanted as single (n=46) or double (n=46) grafts based on donor age, renal function, medical history, histological findings and perfusion flow. Univariate and multivariate analyses detected type of Tx (single vs. double) as the strongest variable associated with graft function: double graft better than single graft. Old donor age, low donor eGFR, high histological scores, and low renal perfusion flow were associated with poor 1-yr renal function. The scoring system was made based on the donor variables (the higher the score, the worse the predicted 1-yr eGFR): age, terminal eGFR, glomerulosclerosis, interstitial fibrosis, arteriosclerosis, and perfusion flow. A score was adjusted for double KTx because of its better graft function. Ninety percent of patients with a total score less than 7 had 1-yr eGFR of 40 mL/min/1.73m2 or higher, while 43% of patients with a total score greater than 11 had 1-yr eGFR of 40 or lower. Graft survival at 2-yr was 100%, 90%, 78%, and 79% for each quartile of patients stratified by total donor scores. A donor scoring system including histological and perfusion parameters may be useful in predicting KTx outcomes for patients receiving ECD/DCD kidneys. Double KTx should be considered for kidneys with high scores.

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