Identifying Risk Severity Using Proposed “Wuhan Chart (Risk Severity Scale)” in Deceased Donor Kidney Transplantation

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Abstract

Introduction and Objective

To find etiological risk factors for deceased donor kidney transplantation.

Materials and Methods

From January 2009 to December 2015, a total of 130 individuals underwent deceased donor (DBD-48, DCD-82) kidney transplantation. Any complication post transplantation within one year was noted and deceased donor re-studied to determine the probable identifiable risk factors. When reevaluating the donor from the data centre, certain factors identifiable factors like; age of donor, cause of donor death, drugs received (catecholamine, vasopressin), Creatinine > 3mg/dl, duration of anuria, duration of low BB, WIT, and TIT etc were related to more complications, therefore major focused during our study.

Results

Out of 130 cases, 56 cases reported complications like DGF, ureterocele, hydronephrosis, urinary leakage, hematoma, embolisation, chest infection, sepsis even death. Upon reevaluating the recipient and donor, we found that the following are the common risk factors for post transplantation complications in deceased donors: Patients age > 60, death related to CVS was associated with complications, serum creatinine >3mg/dl & drugs administered prior to retrieval (prolong morbidity) is a definite risk for DGF, anuria and SBP (<60 mm of hg) for more than 24 hours increases chances of delay in graft function. Warm ischemia time (WIT) of >20 mns along with higher total ischemic time (TIT) increases risk for delay function (DGF) non-functioning of graft (PNG). We propose a chart (Wuhan Chart, see Figure 1) to evaluate the risk severity scale, greater than 7 always have an increased risk factor than with less than 7.

Conclusion

In the future, deceased donor transplantation will serve as a major organ pool. Identifying risk factors and taking extra precaution will definitely help to minimize complications. Thus, identification of possible risk factors will help to minimize complications and make transplant successful by prolonging graft and patient survival. The WUHAN CHART (Risk Severity Scale) will help to identify common risk factors.

Conclusion

Figure 1. Wuhan Chart (Risk Severity Scale)

Conclusion

DEMOGRAPHIC FEATURES -REMARK - SCORE

Conclusion

Age (<60/>60)= 0/1

Conclusion

Cause of Death (CVD/Others)=1/0

Conclusion

Drugs (Catecholamine/Vasopressin) (Yes/No)=1/0

Conclusion

S Creatinine at organ Retrieval (<3.0 mg/dl/>3.0 mg/dl)=0/2

Conclusion

Body Temperature @ Retrieval (<38o c/>38o c);=1/0

Conclusion

Duration of Anuria (<24 hr/>24 hr)=0/2

Conclusion

Duration of Low SBP (<24 hr/>24 hr)=0/2

Conclusion

Warm Ischemia Time (<20 mns/>20 mns)=0/2

Conclusion

Total Ischemia Time (<24 hr/>24 hr)=0/2

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