Introduction: As the Canadian population has aged the gap between renal graft availability and recipient need has continued to widen. Intra-operative organ assessment is known to be associated with organ discard. The Canadian Anatomic Kidney Score (CAKS) is a numeric, multifactorial system, we have shown to be correlated with delayed graft function as well as KDPI. We hypothesize that this system is highly reproducible across clinicians with variable levels of experience, enabling implementation across institutions. Methods: An anonymous survey was distributed to surgical attendings, fellows and residents at teaching centres across Canada. These surveys contained images of 6 separate kidneys (2 images each) at the time of intra-operative back table dissection. Participant demographics were collected. Images were given scores for 3 factors: vascular (calcifications/location), anatomic (cysts/scars), and sticky fat (proportion of adherent fat); with scores between 0 points (ideal) and 2 points (unfavourable). Respondents were stratified by level of training and specialty. Participant scores were compared in subgroups of residents, fellows and staff using a one way ANOVA. Pair-wise exclusion a Cronbach’s alpha was calculated overall and for each scoring factor Results: Of the 46 respondents, 31 had undergone or were undergoing Urology residency, 12 General Surgery, and 2 Vascular Surgery(Table 1). 61% of participants were attending physicians, 13% fellows and 26% residents. Of the 18 questions during the survey there was no significant difference between fellow, resident and attending scoring except for 2/6 sticky fat image sets (Table 2). Cronbach a=0.98, for overall CAKS. Conclusions: Overall the CAKS represents a reproducible scoring system across multiple levels of training, in centres across Canada. These scores were reliably generated, despite only 2 images shown of each kidney. Increasing training level correlated with consistency in rating suggesting that this score can capture some degree of surgical judgement. CAKS may offer a concrete system to incorporate clinical judgement into prognostication and graft selection in kidneys with an equivocal KDPI score. SOURCE OF Funding: none
