Identifying risk factors in renal allografts before transplant: machine-measured renal resistance and posttransplant allograft survival.

Enhancement of renal allograft function and survival in an era where expanded criteria donors are increasingly used requires validated selection criteria. The goal of this retrospective study was to evaluate the significance of pretransplant donor and allograft parameters to identify risk factors that can be used in a model to predict 1-year allograft outcomes. Donor demographic factors, donor type, and allograft parameters such as biopsy results and machine-measured renal resistance were correlated with 1-year graft outcome. The Kaplan-Meier method was used to estimate graft survival using the categorical predictors of donor type, donor age, and machine measured renal resistance at 1.5, 3, and 5 hours. The log-rank test was used to test the difference in survival curves between cohorts. The Cox regression analysis was used to estimate hazard ratios for machine-measured renal resistance, donor age, donor terminal creatinine level, donor's estimated glomerular filtration rate, cold ischemia time, and percent glomerulosclerosis. The data show that machine-measured renal resistance at 3 and 5 hours has a statistically significant inverse relationship to 1-year graft survival. All other risk factors had no correlation with 1-year graft survival. The machine-measured renal resistance at 3 hours is the earliest significant predictor of 1-year allograft outcome.

Modified technique for recovering aortoiliac homografts.

BACKGROUND: Infection of the prosthetic aortic graft bypass remains one of the most serious complications of aortoiliac bypass grafts. Use of an aortoiliac allograft as a replacement for an infected prosthetic graft is an effective treatment for this problem. However, the availability of aortoiliac grafts is affected by the high rate of procurement errors experienced during recovery. This overall error rate nationally averaged 32.5% in 2006, of which nearly a third (9.6%) were related to tears of the intima at or below the bifurcation of the abdominal aorta. OBJECTIVE: To analyze the potential of a new aortoiliac graft recovery method in reducing the error rate. METHOD: A modified technique of aortoiliac graft recovery was used to minimize the possibility of intimal tears. The essence of this technique is to change the sequence of mobilization of the graft, starting from the zone of low resistance, which is at the iliac arteries, and continuing upward to the abdominal aorta, which has higher resistance because of the greater thickness of the aortic wall. An additional modification of the standard technique is to use a tourniquet to raise the aortic edges. CONCLUSION: The aortoiliac graft has various resistances to tearing owing to the different wall thicknesses of the aorta and the iliac arteries. Mobilization of the abdominal aorta before dissection of the iliac arteries creates a high risk of tears at and around the bifurcation of the aorta and the iliac arteries.