57 Agreement in visual quality assessment of donated livers and kidneys among consultant surgeons

Abstract Introduction Surgeons' visual assessments represent the most common reason for non-utilisation of kidneys and livers retrieved for transplantation. While variability in organ acceptance between transplant centres is recognised, the influence of differences in subjective visual evaluations remains unclear. This study investigates inter-rater agreement amongst consultant transplant surgeons visually assessing organs for transplantation. Methods The study included 433 photographs (293 liver, 140 kidney), assessed by at least two transplant surgeons with over five years’ experience. Participants included eight surgeons from five centres for kidney photographs, and ten surgeons from six centres for liver photographs. Inter- and intra-rater agreements were determined with Gwet’s agreement coefficient (AC). Results There was excellent inter-rater agreement for liver steatosis across all levels (none/mild/moderate/severe), AC 0.81 (95%CI:0.76-0.86). Overall quality (good/moderate/poor) agreement was significantly lower in “good" vs “poor” quality livers, AC 0.86 (95%CI:0.75-0.97) vs AC 0.57 (95%CI:0.43-0.71), p<0.05. For kidney assessments, inter-rater agreement on global perfusion was excellent across all levels (good/fair/poor/patchy), AC 0.83 (95%CI:0.73-0.93). Agreement on overall quality was mixed, ranging from AC 0.94 (95%CI:0.73-1.00) for “good” kidneys, to AC 0.70 (95%CI:0.56-0.84) for “moderate” kidneys. Intra-rater agreement for both organs was consistently high (AC>0.86). Conclusions Despite excellent agreement among consultants on specific visual characteristics, there was a notable decrease in agreement when assessing overall quality. Clinicians concur on objective findings, but differ in how they weigh these observations when determining an organ's suitability for transplantation. These subjective differences may contribute to the variable organ acceptance rates across centres.