Outcomes of organ transplants when the donor is a prior recipient

Abstract

Organ shortage continues to challenge the field of transplantation. One potential group of donors are those who have been transplant recipients themselves, or Organ Donation After Transplant (ODAT) donors. We conducted a retrospective cohort study to describe ODAT donors and to compare outcomes of ODAT grafts versus conventional grafts. From October 1, 1987 to June 30, 2015, 517 former recipients successfully donated 803 organs for transplant. Former kidney recipients generally survived a median of approximately 4 years before becoming an ODAT donor whereas liver, lung, and heart recipients generally survived less than a month prior to donation. In the period June 1, 2005 to December 31, 2014, liver grafts from ODAT donors had a significantly higher risk of graft failure compared to non-ODAT liver transplants (P = .008). Kidney grafts donated by ODAT donors whose initial transplant occurred >1 year prior were associated with significantly increased graft failure (P = .012). Despite increased risk of graft failure amongst certain ODAT grafts, 5-year survival was still high. ODAT donors should be considered another form of expanded criteria donor under these circumstances.

The Deceased Transplant Recipients: A Forgotten Source of Organ Donors

“…Re-used kidneys were treated for rejection within the first year after transplant (15.2%) in significantly higher numbers than conventional kidney recipients (9.6%, p = 0.047) and had a significantly lower 5-year graft survival rate if they had been surviving more than 1 year in the first host (p = 0.014), most probably as a result of prior exposure to toxic doses of calcineurin inhibitor and rejection episodes. Both conventional and re-used kidneys transplanted for less than 1 year had similar graft survival rates of around 75-78% at a mean of 5 years, whereas those kidneys from donors with long survival time demonstrated 5-year survival of 60% [35]. When one considers that the 5-year survival is roughly 40% for patients on hemodialysis and 50% for those on peritoneal dialysis, with over 7000 individuals on the waiting list dying or too sick to transplant annually, the re-used kidneys certainly have provided an opportunity for many transplant candidates to have a reasonable quality of life expectation.…”

“…The small number of case reports scattered during the last three decades [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] did not catch the attention of the transplant community until analyses were published from the organ transplant agencies on both sides of the Atlantic [33][34][35]. Lowell et al, with data of the United Network for Organ Sharing and The Scientific Transplant Registry, reported findings on forty-eight recipients of previously re-used kidneys transplanted between October 1987 and June 1996 and compared them to those of 68,568 patients receiving native organs during the same period [33].…”

“…There was no difference in the incidence of graft rejection and graft survival in the two groups, with p = NS and p = 0.20, respectively. Lee et al [35] extended the previous search to 30 June 2015, with 517 donors and 397 explanted transplant kidneys, with a 7.8-fold increase in re-used organs. This consisted of 109 from living donors, or 34.9%, presumably with excellent function and anatomy [26].…”

Pre-transplant donor HBV DNA+ and male recipient are independent risk factors for treatment failure in HBsAg+ donors to HBsAg- kidney transplant recipients

“…As the demand of organ transplantation continues to increase in the past decades, more and more medical facilities are facing serious issues including organ shortage [1][2][3]. This is always of great concern among transplant clinicians over the years, and it pushed the transplant centers to expand the criteria of accepting donors, including older age of 70 to 80, with significant medical history, with abnormal social behavior, or a concurrent history of hepatitis B or C virus exposure [4][5][6][7][8]. As reported by the World Health Organization in 2019, 257 million people were living with chronic hepatitis B virus (HBV) infection, defined by hepatitis B surface antigen positive (HBsAg+).…”

Pre-Transplant Donor HBV DNA+ and Male Recipient are Independent Risk Factors for Treatment Failure in HBsAg+ Donors to HBsAg- Kidney Transplant Recipients

“…[1][2][3] This is always of great concern among transplant clinicians over the years, and it pushed the transplant centers to expand the criteria of accepting donors including older age of 70 to 80, with signi cant medical history, with abnormal social behavior, oe a concurrent history of hepatitis B or C virus exposure. [4][5][6][7][8] As reported by the World Health Organization in 2019, 257 million people were living with chronic hepatitis B virus (HBV) infection, identi ed by hepatitis B surface antigen positive (HBsAg+), however, the prevalence of HBV infection rate varies among the world, with the lowest 0.7% in Americas, and the highest 6.2% in the western paci c. [9] Moreover, with the 6.2% potential donors in China were HBsAg+, proper utilization of these organs may provide undeniable bene t. [10] But, the concern of transmitting HBV infection to the recipients both hepatic and extrahepatic has never been eased solved. Thus, the previous clinical practice on HBsAg + donors were limited to HBsAg + recipients which restricted their great use.…”