Centers for Disease Control ‘High-Risk’ Donors and Kidney Utilization

Duan, Kunfeng; Englesbe, Michael J.; Volk, Michael L.

doi:10.1111/j.1600-6143.2009.02931.x

Cited by 87 publications

(96 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, UNOS mandates centers obtain special informed consent when an IRD organ is transplanted (7), and some patients are unwilling to accept IRD offers (8, 9). Furthermore, these organs are perceived to carry increased legal risk (10, 11), and a study in 2010 found that IRD organs were discarded at 1.5 times the rate of comparable non-IRDs (12). …”

Section: Introductionmentioning

confidence: 99%

Landscape of Deceased Donors Labeled Increased Risk for Disease Transmission Under New Guidelines

Kucirka

Bowring

Massie

et al. 2015

American Journal of Transplantation

View full text Add to dashboard Cite

Deceased donors are labeled increased risk for disease transmission (IRD) if they meet certain criteria. New PHS guidelines were recently implemented; the impact of these changes remains unknown. We aimed to quantify the impact of the new guidelines on the proportion of deceased donors labeled IRD, as well as demographic and clinical characteristics. We used Poisson regression with an interaction term for era (new versus old guidelines) to quantify changes. Under the new guidelines, 19.5% donors were labeled IRD, compared to 10.4%, 12.2%, and 12.3% in the 3 most recent years under the old guidelines (IRR = 1.45, p<0.001). Increases were consistent across OPOs: 44/59 had an increase in the percent of donors labeled IRD, and 25 OPOs labeled >25% of their donors IRD under the new guidelines (versus 5 OPOs under the old). African-Americans were 52% more likely to be labeled IRD under the new guidelines (RR=1.52, p=0.01). There has been a substantial increase in donors labeled IRD under the new PHS guidelines; it is important to understand the mechanism and consequences to ensure an optimal balance of patient safety and organ utilization is achieved.

show abstract

Section: Introductionmentioning

confidence: 99%

Landscape of Deceased Donors Labeled Increased Risk for Disease Transmission Under New Guidelines

Kucirka

Bowring

Massie

et al. 2015

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…21 These PHSdesignated kidneys have a 33% higher odds of discard compared with other kidneys (OR 0.67 [95% CI 0.61-0.74]). 22 Yet, for most patients, the absolute risk of donor disease transmission is much lower than the risk of continuing dialysis. Specifically, if nucleic acid testing is used to screen the donor for infection, the estimated risk of HCV transmission ranges from 0.027 (for a hemophiliac donor) to 32.4 (if the donor used injection drugs) per 10,000 transplants.…”

Section: Organ Acceptance and Risks Of Disease Transmissionmentioning

confidence: 99%

New Solutions to Reduce Discard of Kidneys Donated for Transplantation

Reese

Harhay

Abt³

et al. 2016

Journal of the American Society of Nephrology

131

132

View full text Add to dashboard Cite

Kidney transplantation is a cost-saving treatment that extends the lives of patients with ESRD. Unfortunately, the kidney transplant waiting list has ballooned to over 100,000 Americans. Across large areas of the United States, many kidney transplant candidates spend over 5 years waiting and often die before undergoing transplantation. However, more than 2500 kidneys (.17% of the total recovered from deceased donors) were discarded in 2013, despite evidence that many of these kidneys would provide a survival benefit to wait-listed patients. Transplant leaders have focused attention on transplant center report cards as a likely cause for this discard problem, although that focus is too narrow. In this review, we examine the risks associated with accepting various categories of donated kidneys, including discarded kidneys, compared with the risk of remaining on dialysis. With the goal of improving access to kidney transplant, we describe feasible proposals to increase acceptance of currently discarded organs.

show abstract

“…Donors were classified as CDC high risk if they were incarcerated, used intravenous drugs, engaged in high-risk sexual behaviors, had hemophilia requiring human derived factor replacement or were exposed to HIV in the last twelve months [13]. The functional definition of delayed graft function (DGF) was used instead of the traditional dialysis based definition as it has been shown to be a more objective and superior metric for allograft outcomes.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Renal Transplantation in HIV-1 Associated Nephropathy

et al. 2015

View full text Add to dashboard Cite

IntroductionSeveral studies have demonstrated that renal transplantation in HIV positive patients is both safe and effective. However, none of these studies have specifically examined outcomes in patients with HIV-associated nephropathy (HIVAN).MethodsMedical records of all HIV-infected patients who underwent kidney transplantation at Johns Hopkins Hospital between September 2006 and January 2014 were reviewed. Data was collected to examine baseline characteristics and outcomes of transplant recipients with HIVAN defined pathologically as collapsing focal segmental glomerulosclerosis (FSGS) with tubulo-interstitial disease.Results and DiscussionDuring the study period, a total of 16 patients with HIV infection underwent renal transplantation. Of those, 11 patients were identified to have biopsy-proven HIVAN as the primary cause of their end stage renal disease (ESRD) and were included in this study. They were predominantly African American males with a mean age of 47.6 years. Seven (64%) patients developed delayed graft function (DGF), and 6 (54%) patients required post-operative dialysis within one week of transplant. Graft survival rates at 1 and 3 years were 100% and 81%, respectively. Acute rejection rates at 1 and 3 years were 18% and 27%, respectively. During a mean follow up of 3.4 years, one patient died.ConclusionsAcute rejection rates in HIVAN patients in this study are higher than reported in the general ESRD population, which is similar to findings from prior studies of patients with HIV infection and ESRD of various causes. The high rejection rates appear to have no impact on short or intermediate term graft survival.

show abstract

Centers for Disease Control ‘High-Risk’ Donors and Kidney Utilization

Cited by 87 publications

References 12 publications

Landscape of Deceased Donors Labeled Increased Risk for Disease Transmission Under New Guidelines

Landscape of Deceased Donors Labeled Increased Risk for Disease Transmission Under New Guidelines

New Solutions to Reduce Discard of Kidneys Donated for Transplantation

Outcomes of Renal Transplantation in HIV-1 Associated Nephropathy

Contact Info

Product

Resources

About