Validation of KDRI/KDPI for the selection of expanded criteria kidney donors. / Validación del KDRI/KPDI para la selección de donantes renales con criterios expandidos.

INTRODUCTION: KDRI / KDPI are tools use in kidney donor evaluation. It has been proposed as a substitute of, or complementary to preimplantation renal biopsy. These scores has not been validated in Spain. OBJECTIVE: 1) To investigate the concordance between KDPI and histological scores (preimplantation renal biopsy) and 2) To assess the relationship between KDRI, KDPI and histological score on graft survival in the expanded criteria donors group. METHODOLOGY: Retrospective cohort study from 1 January 1998 until 31 December 2010. RESULTS: During the study 120 donors were recruited, that resulted in 220 preimplantation renal biopsies. 144 (65%) grafts were considered suitable for kidney transplantation. 76 (34.5%) were discarded. Median follow up has been 6.4 years (sd 3.9). Median age 63.1 years (sd 8.2), males (145; 65.9%), non-diabetic (191; 86.8%) and without another cardiovascular risk factors (173; 78.6%). 153 (69.5%) donors died of cerebrovascular disease. There were significant differences in KDRI/KDPI score in both groups 1.56/89 (sd 0.22) vs 1.66/93 (sd 0.15), p<0.01). The KDPI showed moderate concordance and correlation with the histological score (AUC 0.64 / correlation coefficient 0.24, p <0.01). KDPI (HR 24.3, p<0.01) and KDRI (HR 23.3, p<0.01) scores were associated with graft survival in multivariate analysis. CONCLUSION: 1) KPDI and histological scores show moderate concordance. The utility of both scores as combined tools it has to be determined. 2) KDPI score, and especially KDRI score, are valid for estimating graft survival and combined with the biopsy can help to individualized decision making in the expanded criteria donors pool.

[Correct placement of left-sided double lumen endotracheal tubes: a simple verification technique]. / Un método sencillo para ayudar a la comprobación del correcto posicionamiento de los tubos endotraqueales de doble luz izquierdos.

OBJECTIVE: Double lumen endotracheal tubes (DLTs) are used in thoracic surgery for selective bronchial intubation, which is required for single lung ventilation. Correct placement of the tube is checked by means of fiberoptic bronchoscopy. We present a simple alternative method to help confirm the correct placement of left-sided DLTs. The method consists of passing a suction catheter through the tracheal lumen of the tube. Our hypothesis was that if the catheter can be inserted without difficulty, the tube is correctly placed. The objective was to determine the sensitivity and specificity of that criterion. MATERIAL AND METHODS: We studied patients scheduled for elective left pneumonectomy or lobectomy. After passing the catheter through the left-sided DLT, placement was checked by means of fiberoptic bronchoscopy (gold standard) and the results were compared with the placement assessment based on ease of insertion. RESULTS: One hundred patients were included. The DLT was judged to be correctly placed in 88% of patients in whom the catheter was inserted without resistance. Bronchoscopy corroborated this finding in 84% of cases; the tube was found to be incorrectly placed in the remaining 4% of cases and had to be reinserted. Resistance was noted in 12% of cases and bronchoscopy confirmed that the tube was incorrectly placed in those patients. CONCLUSIONS: This technique can be very useful in placing left-sided DLTs in situations where fiberoptic bronchoscopy is not available and if the anesthesiologist has a thorough command of the method. Our results support the routine use of this criterion as it is simple and easy to learn. It should be remembered, however, that confirmation of placement by means of fiberoptic bronchoscopy is currently the gold standard technique.