Background
Transmission of human immunodeficiency virus (HIV) and hepatitis C to transplant recipients has drawn attention to the use of allografts from seronegative donors at increased risk for viral infection (DIRVI).
Methods
We performed a cohort study of 7,803 kidney transplant recipients whose kidneys were recovered through one of two organ procurement organizations (OPO) from 1996 to 2007. Detailed OPO data on donor risk factors were linked to recipient data from the Organ Procurement and Transplantation Network.
Results
Median recipient follow-up was 3.9 years. 368 (5%) patients received DIRVI kidneys, a third of which were procured from donors with a history of injection drug use or commercial sex work. Compared to standard criteria kidney recipients, DIRVI kidney recipients were more likely to be HIV-positive or Black. In multivariable Cox regression, using DIRVI recipients as the reference, recipients of standard criteria donor kidneys had lower mortality (HR 0.71, p<0.01) and no difference in death-censored allograft failure (HR 1.09, p=0.62), whereas recipients of expanded criteria donor kidneys had no significant difference in mortality (HR 0.98, p=0.83), but a higher allograft failure rate (HR 1.93, p<0.01). High-quality data on post-transplant recipient viral testing were not available.
Conclusions
DIRVI kidney recipients experienced higher mortality than standard criteria kidney recipients. This finding could be explained if sicker patients received DIRVI kidneys (i.e., residual confounding) or the less likely possibility of undetected transmission of viral infections. Given the limitations of registry data used in this analysis, prospective studies are needed to further elucidate these findings.