All Good Things Come Those Who Wait Doesn’t Apply to Increased Risk Kidney Donors

KDPI is a term that is applied to kidneys from donors to summarize how risky the donated organ is expected to be. Some of the components of KDPI include disease like hepatitis. The potential of carrying a blood borne disease makes a donor an increased risk donor or IRD. Guidelines have been published on reducing HIV, HBR and HCV transmission through organ transplantation.

Despite research demonstrating that these donors have equal or better post-transplant graft and patient, increased risk kidneys are less likely to be used than organs from non-increased risk donors. A study and editorial in the American Journal of Transplantation addresses this by looking at the transplant outcomes of these more riskier organs. This work ultimately comes from Dorry Segev and the group at Johns Hopkins, who are pioneering a lot of the IRD and HIV/hepatitis organ donor transplantation.

The authors looked at almost 105,000 kidney transplant candidates who were initially offered an IRD kidney. About 1/3 of these who were offered an IRD but refused had to wait 5 years before they were offered a non-IRD kidney. Furthermore, the median KDPI of the offered non-IRD kidney was higher than the original IRD they declined, 52 and 21 respectively. That means they had to wait 5 years to get a overall worse kidney! The following graph represents this last point.

graph-1

Those who accepted the initial IRDs did better too. They had a 1/3 less risk of death at 6 months and a 50% lower risk of death after 6 months. Again the following graph represents this outcome.

graph 2.PNG
There will never not be any risk of transmitting HCV or HIV from organ to recipient. It is a low, however, present risk. The risk of disease transmission of HCV ranges from <1 in 1,000 and for HIV to <1 in 10,000 transplants. But accepting an IRD kidney has a clear long‐term survival benefit; and we should be counseling patients to consider taking IRD offers as the benefits outweigh the risks.

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