Systematic Surgical Assessment of Deceased-Donor Kidneys as a Predictor of Short-Term Transplant Outcomes.

BACKGROUND: Short-term kidney graft dysfunction is correlated with complications and it is associated with a decreased long-term survival; therefore, a scoring system to predict short-term renal transplant outcomes is warranted. AIM: The aim of this study is to quantify the impression of the organ procurement surgeon in correlation with the following kidney transplant outcomes: immediate graft function (IGF), delayed graft function (DGF), and primary nonfunction (PNF). Results are compared to factors associated with the 1-year outcome. METHODS: A regional prospective pilot study was performed using deceased-donor organ assessment forms to be filled out by procurement surgeons after procurement. Data were gathered on kidney temperature, perfusion, anatomy, atherosclerosis, and overall quality. RESULTS: Included were 90 donors who donated 178 kidneys, 166 of which were transplanted. Variables that were significantly more prevalent in the DGF-or-PNF group (n = 65) are: large kidney size (length, p = 0.008; width, p = 0.036), poor perfusion quality (p = 0.037), lower diuresis (p = 0.039), fewer hypotensive episodes (p = 0.003), and donation-after-circulatory-death donors (p = 0.017). Multivariable analysis showed that perfusion quality and kidney width significantly predicted the short-term outcome. However multivariable analysis of long-term outcomes showed that the first measured donor creatinine, kidney donor risk index, IGF vs. DGF+PNG, and kidney length predicted outcomes. CONCLUSIONS: Results show that short-term graft function and 1-year graft function indeed are influenced by different variables. DGF and PNF occur more frequently in kidneys with poor perfusion and in larger kidneys. A plausible explanation for this is that these kidneys might be insufficiently washed out, or even congested, which may predispose to DGF. These kidneys would probably benefit most from reconditioning strategies, such as machine perfusion. A scoring system including these variables might aid in decision-making towards allocation and potential reconditioning strategies.

Trauma-Related Clinical Practice Variation in Dutch Emergency Departments.

Structural insights in the use of protocols and the extent of practice variation in EDs are lacking. The objective is to determine the extent of practice variation in EDs in The Netherlands, based on specified common practices. We performed a comparative study on Dutch EDs that employed emergency physicians to determine practice variation. Data on practices were collected via a questionnaire. Fifty-two EDs across The Netherlands were included. Thrombosis prophylaxis was prescribed for below-knee plaster immobilization in 27% of EDs. Vitamin C was prescribed in 50% of EDs after a wrist fracture. Splitting of applied casts to the upper or lower limb was performed in one-third of the EDs. Analysis of the cervical spine after trauma was performed by the NEXUS criteria (69%), the Canadian C-spine Rule (17%) or otherwise. The imaging modality for cervical spine trauma in adults was a CT scan (98%). The cast used for scaphoid fractures was divided between the short arm cast (46%) and the navicular cast (54%). Locoregional anaesthesia for femoral fractures was applied in 54% of the EDs. EDs in The Netherlands showed considerable practice variation in treatments among the subjects studied. Further research is warranted to gain a full understanding of the variation in practice in EDs and the potential to improve quality and efficiency.