58 Agreement in visual organ quality assessment: A comparative study between trainees and consultants Free

Optimising organ utilisation relies on accurate organ quality assessments. Though multiple factors influence decisions, subjective visual assessments of hepatic steatosis and renal perfusion remain the most reported reasons of non-utilisation of retrieved organs. Initial evaluations are typically conducted by trainee surgeons. This study assesses agreement of organ quality assessments between trainee and consultant transplant surgeons.

Surgeons were categorised as consultants (≥5 years experience) or trainees (<5 years experience). Nineteen surgeons (10 consultants, 9 trainees) from 8 centres assessed liver quality, and 17 surgeons (8 consultants, 9 trainees) from 8 centres evaluated kidney quality. Visual characteristics (Hepatic Steatosis – None/Mild/Moderate/Severe; Renal Perfusion – Good/Fair/Poor/Patchy) and overall organ quality (Good/Moderate/Poor) were scored. Inter-rater agreement on images reviewed by both trainees and consultants was determined.

Photographs of 324 livers and 284 kidneys were assessed. Agreement between consultant and trainee surgeons on hepatic steatosis was poor (AC=0.36, 95%CI:0.31-0.41), while liver overall quality was moderate (AC=0.62, 95%CI:0.58-0.66). When disagreeing, trainees overestimated severity of steatosis, odds ratio OR=1.99 (95%CI:1.62-2.45), and overall quality, OR=1.47 (95%CI:1.14-1.89). Renal perfusion agreement was moderate (AC=0.55, 95%CI:0.49-0.61), with moderate to good agreement for overall quality (AC=0.64, 95%CI:0.59-0.69). Trainees again overestimated severity, OR=1.61 (95%CI:1.24-2.08) for perfusion quality and OR=1.50 (95%CI:1.16-2.18) for overall quality.

Trainees were more likely to overestimate severity during visual assessments. This underscores the importance of implementing decision aid tools, especially when retrievals are conducted by less experienced transplant surgeons, to optimise the use of donated organs and reduce unnecessary discards.