The Canadian Anatomic Kidney Score Assessment of reproducibility among surgeons and trainees across Canada

The Canadian Anatomic Kidney Score (CAKS) is a quantitative score used to assess donor kidneys, which has been shown to predict transplant outcomes. We hypothesized that the quantification of this score is highly reproducible across surgeons with varying levels of experience.

An anonymous survey was distributed to surgical attendings, fellows, and residents at teaching centers across Canada. The survey included photographs of six distinct kidneys (two images for each) taken during intraoperative back-table dissection. Participants evaluated the kidneys based on vascular features, anatomy, and sticky fat. Scores ranged from 0-2 points for each category. Comparisons of mean scores among residents, fellows, and staff were made using one-way ANOVA, and the intraclass correlation coefficient (ICC) was calculated for each scoring factor and overall.

Among the 35 respondents, 570 sets of evaluations were performed, with a mean evaluation time of one minute 37 seconds per kidney. Across the 18 survey questions, there was no significant difference in scoring among fellows, residents, and attendings, except for two of the six "sticky fat" image sets. The ICC for the CAKS overall was 0.78 when evaluated against a gold standard, and 0.80 when compared between raters, indicating excellent agreement between groups.

CAKS is reproducible by surgeons across different levels of training and various centers in Canada. This scoring system provides a reliable means to convey quantitative anatomic information between transplant professionals.