Outcomes for potential kidney transplant recipients offered public health service increased risk kidneys: A single‐center experience

• Published in: Clinical transplantation 2018-12, Vol.32 (12), p.e13427-n/a
• Main Authors: Fernandez, Hilda E., Chiles, Mariana C., Pereira, Marcus, Husain, Syed Ali, Miko, Benjamin, Baral, Prativa, Dale, Leigh‐Anne, Patel, Shefali, Runge, Brian, Tsapepas, Demetra, Sandoval, Pedro Rodrigo, Ratner, Lloyd E., Cohen, David J., Mohan, Sumit
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Donor Selection - standards; donor‐derived disease transmission; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Humans; increased‐risk donors; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - surgery; kidney transplantation; Kidney Transplantation - mortality; Kidney Transplantation - standards; Male; Middle Aged; Patient Safety; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Survival Rate; Tissue and Organ Procurement - standards; Tissue Donors - supply & distribution; Transplant Recipients - statistics & numerical data; United States; United States Public Health Service; viral infection; Waiting Lists - mortality; waitlist; Young Adult
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.13427

Background Discard rate of Public Health Service Increased Risk (PHS‐IR) organs is high despite the absence of worse kidney transplant outcomes. Methods We conducted a retrospective, single‐center study of PHS‐IR kidney offers made to kidney transplant‐only potential recipients from 6/2004 to 5/2015. Overall mortality and transplant outcomes between potential recipients were stratified by response to PHS‐IR kidney offers. Cox regression and Kaplan‐Meier analyses of mortality and allograft failure were performed. Results A total of 2423 potential recipients were offered a PHS‐IR kidney, with 1502 transplanted, with or without a PHS‐IR kidney. Predictors of accepting a PHS‐IR kidney included higher Estimated Post Transplant Survival (EPTS) score, prior kidney transplant, and lower educational achievement on multivariable analysis (P = 0.025, P = 0.004, P = 0.023). A positive response to a PHS‐IR kidney was associated with lower risk of mortality (3.63% vs 11.6%; aHR 0.467, P = 0.0008). PHS‐IR kidney recipients had decreased risk of allograft loss compared to non‐PHS‐IR recipients (P = 0.007), though mortality outcomes were not significantly different based on PHS‐IR status (P = 0.38). No transmission of HIV, HBV, or HCV occurred from PHS‐IR kidney donors in this cohort. Conclusions Efforts must be made to increase awareness of the beneficial outcomes of PHS‐IR organs to maximize appropriate donor allocation.