Renal Transplantation in HIV-Positive Recipients

Locke, Jayme E.; Segev, Dorry L.

doi:10.1007/s11908-009-0078-3

Cited by 6 publications

(4 citation statements)

References 49 publications

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“…A thorough discussion should emphasize the exceedingly low risk of viral transmission [ 3 , 4 ] but also require the patient to express understanding of the need for close surveillance after transplantation, as early recognition of infectious complications can allow early intervention in other recipients [ 11 ]. Furthermore, the patient should be aware that a substantial amount of waitlist mortality results from declined livers, rather than lack of opportunity for transplantation [ 12 ], and that in carefully selected patients an IRD graft may carry a lower chance of death than declining an organ [ 13 ]. An educated patient-provider discussion should be individualized to the patient, their time on the waitlist, and their likelihood of receiving another offer, as all of these have been found to be helpful in identifying the ideal recipient of an IRD graft [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Utilization of Public Health Service Increased Risk Donors Yields Equivalent Outcomes in Liver Transplantation

Fleetwood

Lusciks

Poirier

et al. 2016

Journal of Transplantation

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Background. The PHS increased risk donor (IRD) is underutilized in liver transplantation. We aimed to examine the posttransplant outcomes in recipients of increased-risk organs. Methods. We analyzed 228,040 transplants in the Organ Procurement and Transplantation Network database from 2004 to 2013. Endpoints were graft failure and death. Results were controlled for demographics and comorbidities. Statistical analysis utilized Fisher's test and logistic regression. Results. 58,816 patients were identified (5,534 IRD, 53,282 non-IRD). IRDs were more frequently male (69.2% versus 58.3%, p < 0.001), younger (34 versus 39, p < 0.001), and less likely to have comorbidities (p < 0.001). Waitlist time was longer for IRD graft recipients (254 versus 238 days, p < 0.001). All outcomes were better in the IRD group. Graft failure (23.6 versus 27.3%, p < 0.001) and mortality (20.4 versus 22.3%, p = 0.001) were decreased in IRD graft recipients. However, in multivariate analysis, IRD status was not a significant indicator of outcomes. Conclusion. This is the first study to describe IRD demographics in liver transplantation. Outcomes are improved in IRD organ recipients; however, controlling for donor and recipient comorbidities, ischemia time, and MELD score, the differences lose significance. In multivariate analysis, use of IRD organs is noninferior, with similar graft failure and mortality despite the infectious risk.

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Section: Discussionmentioning

confidence: 99%

Utilization of Public Health Service Increased Risk Donors Yields Equivalent Outcomes in Liver Transplantation

Fleetwood

Lusciks

Poirier

et al. 2016

Journal of Transplantation

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“…A third limitation was the information currently available to estimate mortality given HIV or HCV seroconversion. Most studies suggest that graft and patient survival are comparable between HIV positive and HIV negative transplant recipients especially among carefully selected patients or with risk factors appropriately controlled for . Similar evidence suggests minimal differences in recipient outcomes between HCV positive or negative donors and even a survival advantage (adjusted hazard ratio for death 0.76, 95% CI 0.60–0.96) of HCV positive transplantation over remaining dialysis dependent .…”

Section: Discussionmentioning

confidence: 99%

Identifying Appropriate Recipients for CDC Infectious Risk Donor Kidneys

Chow

Massie

Muzaale

et al. 2013

American Journal of Transplantation

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yBoth authors contributed equally.Over 10% of deceased donors in 2011 met PHS/CDC criteria for infectious risk donor (IRD), and discard rates are significantly higher for kidneys from these donors. We hypothesized that patient phenotypes exist for whom the survival benefit outweighs the infectious risk associated with IRDs. A patient-oriented Markov decision process model was developed and validated, based on SRTR data and meta-analyses of window period risks among persons with IRD behaviors. The Markov model allows patients to see, for their phenotype, their estimated survival after accepting versus declining an IRD offer, graphed over a 5-year horizon. Estimated 5-year survival differences associated with accepting IRDs ranged from À6.4% to þ67.3% for a variety of patient phenotypes. Factors most predictive of the survival difference with IRD transplantation were age, PRA, previous transplant, and the expected time until the next non-IRD deceased donor offer. This study suggests that survival benefit derived from IRD kidneys varies widely by patient phenotype. Furthermore, within the inherent limitations of modelbased prediction, this study demonstrates that it is possible to identify those predicted to benefit from IRD kidneys, and illustrates how estimated survival curves based on a clinical decision can be presented to better inform patient and provider decision-making.

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“…A third limitation was the information currently available to estimate mortality given HIV or HCV seroconversion. Most studies suggest that graft and patient survival are comparable between HIV positive and HIV negative transplant recipients (22)(23)(24)(25) especially among carefully selected patients (26,27) or with risk factors appropriately controlled for (28). Similar evidence suggests minimal differences (29) in recipient outcomes between HCV positive or negative donors and even a survival advantage (adjusted hazard ratio for death 0.76, 95% CI 0.60-0.96) of HCV positive transplantation over remaining dialysis dependent (30).…”

Section: Discussionmentioning

confidence: 99%

Identifying Appropriate Recipients for CDC Infectious Risk Donor Kidneys

Chow

Massie²,

Muzaale³

et al. 2013

American Journal of Transplantation

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y Both authors contributed equally. Over 10% of deceased donors in 2011 met PHS/CDC criteria for infectious risk donor (IRD), and discard rates are significantly higher for kidneys from these donors. We hypothesized that patient phenotypes exist for whom the survival benefit outweighs the infectious risk associated with IRDs. A patient-oriented Markov decision process model was developed and validated, based on SRTR data and meta-analyses of window period risks among persons with IRD behaviors. The Markov model allows patients to see, for their phenotype, their estimated survival after accepting versus declining an IRD offer, graphed over a 5-year horizon. Estimated 5-year survival differences associated with accepting IRDs ranged from À6.4% to þ67.3% for a variety of patient phenotypes. Factors most predictive of the survival difference with IRD trans-plantation were age, PRA, previous transplant, and the expected time until the next non-IRD deceased donor offer. This study suggests that survival benefit derived from IRD kidneys varies widely by patient phenotype. Furthermore, within the inherent limitations of model-based prediction, this study demonstrates that it is possible to identify those predicted to benefit from IRD kidneys, and illustrates how estimated survival curves based on a clinical decision can be presented to better inform patient and provider decision-making.

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Renal Transplantation in HIV-Positive Recipients

Cited by 6 publications

References 49 publications

Utilization of Public Health Service Increased Risk Donors Yields Equivalent Outcomes in Liver Transplantation

Utilization of Public Health Service Increased Risk Donors Yields Equivalent Outcomes in Liver Transplantation

Identifying Appropriate Recipients for CDC Infectious Risk Donor Kidneys

Identifying Appropriate Recipients for CDC Infectious Risk Donor Kidneys

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