Venkatesh K Ariyamuthu1, Burhaneddin Sandikci2, Nashila AbdulRahim1, Christine Hwang3, Malcolm P MacConmara3, Ravi Parasuraman4, Ahsen Atis5, Bekir Tanriover1. 1. Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 2. Booth School of Business, The University of Chicago, Chicago, IL, USA. 3. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 4. Division of Nephrology, University of Michigan, Ann Arbor, MI, USA. 5. Biological Sciences, University of Texas at Dallas, Richardson, TX, USA.
Abstract
BACKGROUND: Kidneys from deceased donors infected with hepatitis C virus (HCV) are underutilized. Most HCV virus-infected donors are designated as Public Health Service increased donors (PHS-IR). Impact of PHS and HCV designations on discard is not well studied. METHODS: We queried the UNOS data set for all deceased donor kidneys between January 2015 and December 2018. The final study cohort donors (n = 38 702) were stratified into three groups based on HCV antibody (Ab) and NAT status: (a) Ab-/NAT- (n = 35 861); (b) Ab+/NAT- (n = 973); and (c) Ab±/NAT+ (n = 1868). We analyzed utilization/discard rates of these organs, the impact of PHS-IR and HCV designations on discard using multivariable two-level hierarchical logistic regression models, forecasted number of HCV viremic donors/kidneys by 2023. RESULTS: During the study period, (a) the number of viremic donor kidneys increased 2 folds; (b) the multilevel mixed-effects logistic regression models showed that, overall, the PHS labeling (OR 1.20, CI 95% CI 1.15-1.29) and HCV designation (OR 2.29; 95% CI 2.15-2.43) were independently associated with increased risk of discard; (c) contrary to the general perception, PHS-IR kidneys across all HCV groups, compared to PHS-IR kidneys were more likely to be discarded; (d) we forecasted that the number of kidneys from HCV viremic donor kidneys might increase from 1376 in 2019 to 2092 in 2023. CONCLUSION: Hepatitis C virus viremic kidneys might represent 10%-15% of deceased donor organ pool soon with the current rate of the opioid epidemic. PHS labeling effect on discard requires further discussion of the utility of this classification.
BACKGROUND: Kidneys from deceased donors infected with hepatitis C virus (HCV) are underutilized. Most HCV virus-infected donors are designated as Public Health Service increased donors (PHS-IR). Impact of PHS and HCV designations on discard is not well studied. METHODS: We queried the UNOS data set for all deceased donor kidneys between January 2015 and December 2018. The final study cohort donors (n = 38 702) were stratified into three groups based on HCV antibody (Ab) and NAT status: (a) Ab-/NAT- (n = 35 861); (b) Ab+/NAT- (n = 973); and (c) Ab±/NAT+ (n = 1868). We analyzed utilization/discard rates of these organs, the impact of PHS-IR and HCV designations on discard using multivariable two-level hierarchical logistic regression models, forecasted number of HCV viremic donors/kidneys by 2023. RESULTS: During the study period, (a) the number of viremic donor kidneys increased 2 folds; (b) the multilevel mixed-effects logistic regression models showed that, overall, the PHS labeling (OR 1.20, CI 95% CI 1.15-1.29) and HCV designation (OR 2.29; 95% CI 2.15-2.43) were independently associated with increased risk of discard; (c) contrary to the general perception, PHS-IR kidneys across all HCV groups, compared to PHS-IR kidneys were more likely to be discarded; (d) we forecasted that the number of kidneys from HCV viremic donor kidneys might increase from 1376 in 2019 to 2092 in 2023. CONCLUSION:Hepatitis C virus viremic kidneys might represent 10%-15% of deceased donor organ pool soon with the current rate of the opioid epidemic. PHS labeling effect on discard requires further discussion of the utility of this classification.
Authors: Jiten P Kothadia; Anshul Bhalla; Miklos Z Molnar; Rahul Mohan; Vasanthi Balaraman; Manish Talwar; Ryan Helmick; Corey Eymard; Ian Clark; Richa Jain; Thomas W Faust; Jason M Vanatta; James D Eason; Satheesh P Nair Journal: Transplant Direct Date: 2022-05-26
Authors: Zoe A Stewart; Jeffrey Stern; Nicole M Ali; Harmit S Kalia; Karen Khalil; Srijana Jonchhe; Elaina P Weldon; Rebecca A Dieter; Tyler C Lewis; Nur Funches; Sudara Crosby; Monique Seow; Jonathan C Berger; Nabil N Dagher; Bruce E Gelb; Anthony C Watkins; Nader Moazami; Deane E Smith; Zachary N Kon; Stephanie H Chang; Alex Reyentovich; Luis F Angel; Robert A Montgomery; Bonnie E Lonze Journal: Transplant Direct Date: 2021-09-07