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26.11.2021 | Original Article

Impact of the explanting surgeon’s impression of donor arteriosclerosis on outcome of kidney transplantations from donors aged ≥65 years

verfasst von: Fabian Echterdiek, Constantin Tilgener, Jürgen Dippon, Daniel Kitterer, Justus Scheder-Bieschin, Gregor Paul, Matthias Ott, Ulrich Humke, Vedat Schwenger, Joerg Latus

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 2/2022

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Abstract

Purpose

Careful donor selection is important for kidney transplantations (KT) from suboptimal donors aged ≥65 years. Several tools such as histopathological assessment of preimplant biopsies have been shown to predict allograft survival and can be applied for selection. Whether the explanting surgeon’s appraisal is associated with outcomes of KTs from suboptimal donors is unknown.

Methods

We compared outcomes of KTs from ≥65-year-old deceased donors performed at our centre between 1999 and 2018 for which grading of macroscopic ‘donor arteriosclerosis’ (n=104) and ‘organ quality’ (n=208) as judged by the explanting surgeon and documented on the Eurotransplant kidney organ report was available.

Results

No association was observed between degree of macroscopic donor arteriosclerosis and death-censored graft survival in univariable or multivariable regression analyses. Compared to KTs from donors with no/mild arteriosclerosis, KTs from donors with moderate/severe arteriosclerosis were associated with a significantly impaired allograft function 3 months, 1 year and 3 years after transplantation (e.g. at 3 years: 176.8 µmol/l vs 137.0 µmol/l, P=0.003). Following multivariable regression analysis, these differences remained significant at 3 months and 3 years after KT. No association was observed between degree of macroscopic arteriosclerosis and mortality or primary non-function as well as no consistent association with delayed graft function and histological arteriosclerosis. Assessment of ‘organ quality’ was not associated with outcomes.

Conclusion

Our data suggest that the explanting surgeon’s assessment of donor arteriosclerosis is associated with allograft function. Larger studies and better standardization of kidney inspection after explantation are required to further explore the impact of surgeon’s appraisal in KT.

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Titel: Impact of the explanting surgeon’s impression of donor arteriosclerosis on outcome of kidney transplantations from donors aged ≥65 years
verfasst von: Fabian Echterdiek
Constantin Tilgener
Jürgen Dippon
Daniel Kitterer
Justus Scheder-Bieschin
Gregor Paul
Matthias Ott
Ulrich Humke
Vedat Schwenger
Joerg Latus
Publikationsdatum: 26.11.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Langenbeck's Archives of Surgery / Ausgabe 2/2022
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-021-02383-7

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Impact of the explanting surgeon’s impression of donor arteriosclerosis on outcome of kidney transplantations from donors aged ≥65 years