Estimated benefits of transplantation of kidneys from donors at increased risk for HIV or hepatitis C infection

Kidneys from organ donors who have behaviors that place them at increased risk for infection with human immunodeficiency virus (HIV) or hepatitis C virus (HCV) are often discarded, even if viral screening tests are negative. This study compared policies that would either 'Discard' or 'Transplant' kidneys from Centers for Disease Control classified increased-risk donors (CDC-IRDs) using a decision analytic Markov model of renal failure treatment modalities. Base-case CDC-IRDs were current injection drug users (IDUs) with negative antibody and nucleic acid testing (NAT) for HIV and HCV, comprising 5% of kidney donors. Compared to a CDC-IRD kidney 'Discard' policy, the 'Transplant' policy resulted in higher patient survival, a greater number of quality-adjusted life-years (QALYs) (5.6 vs. 5.1 years per patient), more kidney transplants (990 vs. 740 transplants per 1000 patients) and lower cost of care ($60 000 vs. $71 000 per QALY). The total number of viral infections was lower with the 'Transplant' policy (13.1 vs. 14.8 infections per 1000 patients over 20 years), because the 'Discard' policy led to more time on hemodialysis, with a higher HCV incidence. We recommend that kidneys from NAT-negative CDC-IRDs be considered for transplantation since the practice is estimated to be beneficial from both the societal and individual patient perspective.