Abstract: SA-OR075

Consequences of Declining a Public Health Service Increased Risk (PHS-IR) Donor Kidney

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Fernandez, Hilda E., NYP-CUMC, NYC, New York, United States
  • Chiles, Mariana C., NYP-CUMC, NYC, New York, United States
  • Pereira, Marcus, NYP-CUMC, NYC, New York, United States
  • Husain, Syed Ali, NYP-CUMC, NYC, New York, United States
  • Mohan, Sumit, NYP-CUMC, NYC, New York, United States
Background

The risk of disease transmission from PHS-IR kidney donors is extremely low but the perception increased risk by patients may adversely impact their willingness to accept these organs.

Methods

We performed a retrospective, single-center study of all PHS-IR kidney offers made to patients at Columbia University Medical Center (CUMC) from 6/2004 to 5/2015 to 1) identify who was likely to accept these organs and 2) assess the potential consequences of declining such offer.

Results

Among 2423 candidates who received a PHS-IR kidney offer, 358 accepted and 2065 declined. On multivariate analysis, higher estimated post-transplant survival (EPTS) score (OR=1.005, p=0.025), male sex (OR=1.345, p=0.035), and higher educational achievement (OR=0.693, p=0.025) appear to influence organ offer acceptance. Among those who declined, 57.5% subsequently received a non-PHS-IR transplant while 16.5% remained on the waitlist. Acceptance of a PHS-IR offer was associated with a lower mortality (3.63% vs 11.6%; adjusted HR 0.467, p=0.0008) and PHS-IR allografts were associated with lower death censored allograft failure rates (HR = 0.677, p=0.041).

Conclusion

Declining a PHS-IR kidney offer appears to be associated with a survival disadvantage at our center. This underscores the importance of patient education regarding the risks and benefits of PHS-IR organs. Efforts must be made to increase acceptance of PHS-IR organs in order to improve outcomes for those on the waitlist.

Funding

  • NIDDK Support