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

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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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Availability of data and material

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Code availability

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Author information

Authors and Affiliations

  1. Department of Nephrology, Klinikum Stuttgart - Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany

    Fabian Echterdiek, Daniel Kitterer, Vedat Schwenger & Joerg Latus

  2. Department of Urology and Transplant Surgery, Klinikum Stuttgart - Katharinenhospital, Stuttgart, Germany

    Constantin Tilgener & Ulrich Humke

  3. Institute for Stochastics and Applications, University of Stuttgart, Stuttgart, Germany

    Jürgen Dippon

  4. Department of Interdisciplinary Emergency and Intensive Care Medicine, Klinikum Stuttgart - Katharinenhospital, Stuttgart, Germany

    Justus Scheder-Bieschin & Matthias Ott

  5. Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Klinikum Stuttgart - Katharinenhospital, Stuttgart, Germany

    Gregor Paul

  6. Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany

    Gregor Paul

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  1. Fabian Echterdiek
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  2. Constantin Tilgener
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Contributions

FE: study conception and design; acquisition, analysis and interpretation of data, drafting of manuscript. CT: acquisition of data, critical revision of manuscript. DK: study conception and design, critical revision of manuscript. JD: analysis and interpretation of data, critical revision of manuscript. JSB: acquisition of data, critical revision of manuscript. GP: acquisition of data, critical revision of manuscript. MO: acquisition of data, critical revision of manuscript. UH: study conception and design, critical revision of manuscript. VS: study conception and design, critical revision of manuscript. JL: study conception and design, interpretation of data, drafting and critical revision of manuscript. All authors approved the final version of manuscript.

Corresponding author

Correspondence to Fabian Echterdiek.

Ethics declarations

Ethics approval

The study was approved by the local ethics committee at the University of Tübingen (No. 632/2019 BO2) and performed according to the ethical standards of the Declaration of Helsinki.

Consent to participate

Patient records/data were anonymized and de-identified prior to analysis. Data was only analysed in groups so that identification of individual patients was not possible. The ethics committee at the University of Tübingen stated that no further approval was necessary for this retrospective study.

Consent for publication

See above.

Conflict of interest

J.D. received payments from Klinikum Stuttgart – Katharinenhospital, Department of Nephrology for statistical analysis, preparation of figures and scientific writing of the statistic section of the manuscript. All other authors declare no conflict of interest.

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Cite this article

Echterdiek, F., Tilgener, C., Dippon, J. et al. Impact of the explanting surgeon’s impression of donor arteriosclerosis on outcome of kidney transplantations from donors aged ≥65 years. Langenbecks Arch Surg 407, 727–737 (2022). https://doi.org/10.1007/s00423-021-02383-7

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