Abstract: FR-PO1049

The Impact of Donor Chemical Urine Toxicology on Outcomes of Kidney Transplantation

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • McMahon, Blaithin A., Johns Hopkins University, Baltimore, Maryland, United States
  • Molini, Christopher A., None, Baltimore, Maryland, United States
  • Novick, Tessa Kimberly, Johns Hopkins University, Baltimore, Maryland, United States
  • Menez, Steven, Johns Hopkins University, Baltimore, Maryland, United States
  • Kraus, Edward S., Johns Hopkins University, Baltimore, Maryland, United States
Background

Most transplant centers now accept kidney grafts from victims who have acute chemical intoxications. Despite the widely acceptance of many of these donors the effect of the acute intoxication on kidney graft outcome is poorly understood.

Methods

This is a single center retrospective cohort analysis of 500 patients undergoing deceased donor kidney transplantation (DDKT). Urine toxicology agents tested from donor urine included: alcohol, heroin, cocaine, opioids/methadone, cannabinoids, benzodiazepines and methamphetamine. Delayed graft function (DGF) was defined as the need for dialysis within 1 week of kidney transplantation (KT). Graft failure was defined as the need to return to dialysis. Multiple logistical regression (MLR) analysis was used to assess the odds ratio for DGF and graft failure. MLR models were adjusted for donor age, donor race, donor terminal creatinine, recipient race, cold ischemic time, donation after cardiac death, and preemptive KT.

Results

Of 500 random DDKTs performed at our institution between January 2010 and October 2015, 230 deceased kidney donors (46%) were current drug users. The main chemical toxins detectable in donor urine were: alcohol (n=132, 26 %), heroin (n=80, 16%), opioid/methadone (n=40, 8%), cocaine (n=57, 11%), cannabinoids (n=90, 18%), benzodiazepines (n=15, 3%), methamphetamine (n=19, 4%). 23% of donors had more than one urine toxicology test positive, 13% had more than two tests positive and 5% more than two tests positive. The urine chemical toxicology of kidney donors did not have a significant effect on KT outcomes of DGF and graft failure on adjusted MLR analysis (median follow up of 24 months) (P for odds ratios > 0.05). There was also no association between donors with multiple positive urine chemical toxicology results (greater than 1 or 2 or 3 or 4 agent’s positive in urine) and DGF or graft survival on MLR (p > 0.05).

Conclusion

The use of deceased donor kidney grafts from donors with positive urine chemical toxicology may be a worthwhile method of increasing the availability of scarce donor kidney organs as urine chemical toxicology is not associated with major transplant outcomes.