Implementation of increased viral risk donor waiting list for pre-consented waitlisted recipients in Victoria, Australia
Nina Seng1, Indra Gramnea1, Fiona Hudson6, Rohit D'Costa1, Leanne McEvoy1, Joe Sasadeusz7, Basu Gopal8, Joshua Kausman5, Rosemary Masterson9, Kathy Paizis3, John Kanellis4, Peter Hughes9, David Goodman10, John Whitlam3, Darren Lee2.
1DonateLife Victoria, Carlton, Australia; 2Department of Renal Medicine, Eastern Health Clinical School , Melbourne, Australia; 3Department of Nephrology, Austin Health, Melbourne, Australia; 4Department of Nephrology, Monash Health , Melbourne, Australia; 5Department of Nephrology, Royal Children's Hospital, Melbourne, Australia; 6Victorian Transplantation and Immunogenetics Service, Australian Red Cross Lifeblood, Melbourne, Australia; 7Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia; 8Department of Renal Medicine, Alfred Hospital, Melbourne, Australia; 9Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia; 10Department of Nephrology, St Vincent's Hospital, Melbourne, Australia
Introduction: Increased viral risk donors (IVRDs) with at-risk behaviours for blood borne virus infection and negative nucleic acid testing (NAT) have a low absolute risk of window period infection. A program allocating these kidneys to pre-consented recipients was recently implemented in the state of Victoria, Australia. We reviewed the performance after twelve months in operation.
Materials and Methods: We retrospectively examined the characteristics of IVRDs (defined by Public Health Service (PHS) 2013 criteria and open window periods) (31/07/2018-31/07/2019). Data for comparison with non-IVRDs was available for the first 7 months. Kidney function, serological and NAT results of recipients at 1 and 3 months post-transplantation were analysed. Continuous data was expressed as median (IQR).
Results and Discussion: 33% of waitlisted patients were pre-consented at 12 months post-implementation, increasing from 24% at 7 months. Sixteen IVRDs (28 kidneys) were utilised, comprising 12.6% of all utilised kidney donors. Risk factors included people who inject drugs (57%), increased risk sexual behaviour (31%), imprisonment (6%) and multiple risk factors (6%). NAT was performed 3.0 (1.0-4.3) days after admission. Four IVRDs had abnormal serology results (3 HCV Ab positive, 1 HBcAb and HCV Ab positive) but negative NAT. All recipients but one of HCV Ab positive IVRDs seroconverted, but no viraemia was detected in recipients from all IVRDs to date. Adherence to post-transplant surveillance testing in recipients was 85%. eGFR (CKD-EPI) was 67 (54-77) and 68 (53-81) mL/min/1.73m2 at 1 and 3 months post-transplantation. Compared with non-IVRDs, IVRDs were significantly younger (36 (28-43) versus 53 (36-61) years; P<0.01). Kidney donor profile index (KDPI) was significantly lower (21 (10-39) versus 62 (27-77); P<0.01), more likely ≤20 (50% versus 18%; P<0.05) and none had a KDPI >85 (0% versus 12%; P=0.35). Waiting time was significantly shorter for blood group O recipients (26 (18-29) versus 38 (34-42) months; P=0.001).
Conclusion: IVRDs appear to offer better quality kidneys from a historically under-utilised donor pool and may reduce waiting time. No donor transmission has occurred to date. Increasing the pre-consent rate may improve utilisation and benefit more waitlisted recipients.
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