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Patients who accepted an IRD kidney had lower 5-year mortality than those who declined IRD organs. The Public Health Service has defined behavioral criteria that identify potential donors as increased-risk donors (IRDs) at higher risk for recent infection with hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) (Public Health Rep 2013; 128:247) These donors may be in the “window period” when donor screening assays are negative but transmission of virus to recipients is possible. National policy requires that potential recipients of IRD are consented regarding the risk for donor to recipient transmission. In part as a result of the opioid epidemic, up to 25% of potential donors are IRD (Am J Transplant 2015; 15: 3215). Researchers have now used a national database to compare outcomes of 104,988 potential kidney recipients who received offers from IRDs from 2010 through 2014. Overall, 6.2% accepted an initial IRD offer and another 3.3% declined but later accepted another IRD offer. Among those who declined the offer, 55% did not receive a transplant within 5 years after the offer. Mortality was reduced significantly among those who did versus did not accept the IRD offer (14% vs. 22.5% at 5 years). Further, the quality of the kidney from the IRD donor was significantly higher than non-IRD kidneys that were transplanted subsequently. |
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COMMENT
This study demonstrates a significant benefit for patients who accept a kidney from an IRD donor. Required donor-screening nucleic acid tests (NAT) detect HCV or HIV infection within 2 weeks after infection, and the estimated risk for window-period infection among NAT-negative IRD is <1% (Am J Transplant 2011; 11:1188). In the current era, only two donors have transmitted HIV to recipients (Am J Transplant 2011; 11:1218 and MMWR Morb Mortal Wkly Rep 2011; 60:297) and HCV is now generally curable posttransplant. Data from this study can be used to educate potential recipients regarding the potential benefits of accepting an offer from an IRD donor.