TY - JOUR
T1 - Turn down for what? Patient outcomes associated with declining increased infectious risk kidneys
AU - Bowring, Mary G.
AU - Holscher, Courtenay M.
AU - Zhou, Sheng
AU - Massie, Allan B
AU - Garonzik, Jacqueline
AU - Kucirka, Lauren M.
AU - Gentry, Sommer Elizabeth
AU - Segev, Dorry
N1 - Funding Information:
Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR, United Network for Organ Sharing (UNOS)/OPTN, or the US Government. D.L. Segev, L.M. Kucirka, and A.B. Massie are supported by grant numbers K24DK101828, F30DK095545, and K01DK101677 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), respectively. C.M. Holscher is supported by grant number F32DK109662 from the NIDDK and an American College of Surgeons Resident Research Scholarship. This work was originally presented in preliminary form
Funding Information:
The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR, United Network for Organ Sharing (UNOS)/OPTN, or the US Government. D.L. Segev, L.M. Kucirka, and A.B. Massie are supported by grant numbers K24DK101828, F30DK095545, and K01DK101677 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), respectively. C.M. Holscher is supported by grant number F32DK109662 from the NIDDK and an American College of Surgeons Resident Research Scholarship. This work was originally presented in preliminary form at the American Society of Transplant Surgeons 17th Annual Winter Symposium on January 27, 2017 and at the American Transplant Congress on May 2, 2017.
Publisher Copyright:
© 2017 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2018/3
Y1 - 2018/3
N2 - Transplant candidates who accept a kidney labeled increased risk for disease transmission (IRD) accept a low risk of window period infection, yet those who decline must wait for another offer that might harbor other risks or never even come. To characterize survival benefit of accepting IRD kidneys, we used 2010-2014 Scientific Registry of Transplant Recipients data to identify 104 998 adult transplant candidates who were offered IRD kidneys that were eventually accepted by someone; the median (interquartile range) Kidney Donor Profile Index (KDPI) of these kidneys was 30 (16-49). We followed patients from the offer decision until death or end-of-study. After 5 years, only 31.0% of candidates who declined IRDs later received non-IRD deceased donor kidney transplants; the median KDPI of these non-IRD kidneys was 52, compared to 21 of the IRDs they had declined. After a brief risk period in the first 30 days following IRD acceptance (adjusted hazard ratio [aHR] accept vs decline: 1.22 2.06 3.49 , P =.008) (absolute mortality 0.8% vs. 0.4%), those who accepted IRDs were at 33% lower risk of death 1-6 months postdecision (aHR 0.50 0.67 0.90 , P =.006), and at 48% lower risk of death beyond 6 months postdecision (aHR 0.46 0.52 0.58 , P <.001). Accepting an IRD kidney was associated with substantial long-term survival benefit; providers should consider this benefit when counseling patients on IRD offer acceptance.
AB - Transplant candidates who accept a kidney labeled increased risk for disease transmission (IRD) accept a low risk of window period infection, yet those who decline must wait for another offer that might harbor other risks or never even come. To characterize survival benefit of accepting IRD kidneys, we used 2010-2014 Scientific Registry of Transplant Recipients data to identify 104 998 adult transplant candidates who were offered IRD kidneys that were eventually accepted by someone; the median (interquartile range) Kidney Donor Profile Index (KDPI) of these kidneys was 30 (16-49). We followed patients from the offer decision until death or end-of-study. After 5 years, only 31.0% of candidates who declined IRDs later received non-IRD deceased donor kidney transplants; the median KDPI of these non-IRD kidneys was 52, compared to 21 of the IRDs they had declined. After a brief risk period in the first 30 days following IRD acceptance (adjusted hazard ratio [aHR] accept vs decline: 1.22 2.06 3.49 , P =.008) (absolute mortality 0.8% vs. 0.4%), those who accepted IRDs were at 33% lower risk of death 1-6 months postdecision (aHR 0.50 0.67 0.90 , P =.006), and at 48% lower risk of death beyond 6 months postdecision (aHR 0.46 0.52 0.58 , P <.001). Accepting an IRD kidney was associated with substantial long-term survival benefit; providers should consider this benefit when counseling patients on IRD offer acceptance.
KW - Scientific Registry for Transplant Recipients (SRTR)
KW - clinical research/practice
KW - infection and infectious agents
KW - infectious disease
KW - kidney transplantation/nephrology
KW - organ acceptance
KW - patient survival
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U2 - 10.1111/ajt.14577
DO - 10.1111/ajt.14577
M3 - Article
C2 - 29116674
AN - SCOPUS:85037342447
SN - 1600-6135
VL - 18
SP - 617
EP - 624
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 3
ER -