Identifying Appropriate Recipients for CDC Infectious Risk Donor Kidneys

Chow, Eugene M.; Massie, Allan B.; Muzaale, Abimereki D.; Singer, Andrew L.; Kucirka, Lauren M.; Montgomery, Robert A.; Lehmann, Harold P.; Segev, Dorry L.

doi:10.1002/ajt.12206

Cited by 11 publications

(18 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In such situations, mathematical modeling can inform optimal strategies (11,12) and has been used to inform clinical decisions in organ transplantation. (13)(14)(15) The objective of our study was to identify LT-eligible patients with decompensated cirrhosis who will benefit from HCV treatment pre-LT based on their MELD scores (and those who will not), using a mathematical model. We sought to determine a threshold MELD score below which pre-LT HCV treatment would improve patients' expected life and vice versa, and to determine the factors that influence this threshold.…”

Section: See Editorial On Page 763mentioning

confidence: 99%

Optimal timing of hepatitis C treatment for patients on the liver transplant waiting list

Chhatwal

Samur

Kues³

et al. 2017

Hepatology

View full text Add to dashboard Cite

The availability of oral direct-acting antiviral (DAAs) has altered the hepatitis C virus (HCV) treatment paradigm for both pre- and post-liver transplant (LT) patients. There is a perceived trade-off between pre- versus post-LT treatment of HCV—treatment may improve liver function but potentially decrease the likelihood of a necessary LT. Our objective was to identify LT-eligible patients with decompensated cirrhosis who would benefit (and not benefit) from pre-LT treatment based on their MELD scores. We simulated a virtual trial comparing long-term outcomes of pre- versus post-LT HCV treatment with oral DAAs for patients having MELD scores between 10 and 40. We developed a Markov-based microsimulation model, SIM-LT (simulation of liver transplant candidates), which simulated the life course of patients on the transplant waiting list and after LT. SIM-LT integrated data from recent trials of oral DAAs (SOLAR 1 and 2), United Network for Organ Sharing (UNOS), and other studies. The outcomes of the model included life expectancy, 1-year and 5-year patient survival, and mortality. Model-predicted patient-survival was validated with UNOS data. We found that, at the national level, treating HCV before LT increased life expectancy if MELD ≤ 27, but could decrease life expectancy at higher MELD scores. Depending on the UNOS region, the threshold MELD score to treat HCV pre-LT varied between 23 and 27, and was lower for UNOS regions 3, 10 and 11, and higher for regions 1, 2, 4, 5, 8 and 9. Sensitivity analysis showed that the thresholds were stable. Conclusions Our findings suggest that the optimal MELD threshold below which decompensated cirrhotic patients should receive HCV treatment while awaiting LT is between 23–27, depending on the UNOS region.

show abstract

Section: See Editorial On Page 763mentioning

confidence: 99%

Optimal timing of hepatitis C treatment for patients on the liver transplant waiting list

Chhatwal

Samur

Kues³

et al. 2017

Hepatology

View full text Add to dashboard Cite

show abstract

“…6 One avenue to maximize transplant volume is to use "increased risk" (formerly "high risk") organs, which constitute more than 10% of the donor population. 7 However, their safety has been traditionally a matter of great scrutiny 8 and has not been established in the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

Increased risk organ transplantation in the pediatric population

Wrenn

Callas

Kapoor

et al. 2017

Pediatric Transplantation

View full text Add to dashboard Cite

IRD organs are classified by the Public Health Service to be at above-average risk for harboring human immunodeficiency virus, hepatitis C, and hepatitis B. Traditionally underutilized, there exists even greater reluctance for their use in pediatric patients. We performed a retrospective analysis via the United Network for Organ Sharing database of all pediatric renal and hepatic transplants performed from 2004 to 2008 in the United States. Primary outcomes were patient and graft survival. Proportional hazards regression was performed to control for potentially confounding factors. Waitlist time, organ acceptance rates, and infectious transmissions were analyzed. There were 1830 SRD renal, 92 IRD renal, 1695 SRD hepatic, and 59 IRD hepatic transplants. There were no statistically significant differences in allograft or patient survival in either group. Acceptance rates of IRD organs were lower for kidney (1.5% IRD vs 4.82% SRD) and liver (1.99% IRD vs 4.51% SRD). One transmission of a bloodborne pathogen involving a pediatric recipient out of 7797 unique transplants was reported from 2008 to 2015. IRD organs appear to have equivalent outcomes. Increasing their utilization may improve access to transplant while decreasing wait times and circumventing waitlist morbidity and mortality.

show abstract

“…These guidelines seek to improve organ safety by reducing HIV, HBV, and HCV transmission through transplantation, without unnecessarily decreasing organ availability, given significant clinical need in the setting of a severe organ shortage (3). While the risk that an IRD is infected during the WP is higher relative to a non-IRD, the absolute risk is still very low (published risks ranging from <1 in 1000 for hepatitis C to <1 in 10 000 for HIV) (4,5), and many patients are predicted to derive substantial survival benefit (6). While the IRD label is intended to reduce infectious transmission, there are potential downsides.…”

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

Self Cite

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

Identifying Appropriate Recipients for CDC Infectious Risk Donor Kidneys

Cited by 11 publications

References 28 publications

Optimal timing of hepatitis C treatment for patients on the liver transplant waiting list

Optimal timing of hepatitis C treatment for patients on the liver transplant waiting list

Increased risk organ transplantation in the pediatric population

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

Contact Info

Product

Resources

About