Abstract: SA-OR009
Characteristics and Outcomes of Deceased Donor Kidney Transplants Performed in the US Based on Donor HCV NAT and Recipient HCV Ab Status
Session Information
- Access, Organ Utilization, and Infectious Disease
October 27, 2018 | Location: 24A, San Diego Convention Center
Abstract Time: 06:06 PM - 06:18 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Ariyamuthu, Venkatesh Kumar, UT Southwestern, Richardson, Texas, United States
- Keceli, Cagla, The University of Chicago Booth School of Business, Chicago, Illinois, United States
- Tanriover, Bekir, UT Southwestern, Richardson, Texas, United States
- Sandikci, Burhaneddin, University of Chicago, CHICAGO, Illinois, United States
- Zhong, Yuan, University of Chicago, Booth School of Business, Chicago, Illinois, United States
- AbdulRahim, Nashila, UT Southwestern, Richardson, Texas, United States
- La Hoz, Ricardo M., UT Southwestern Medical Center, Dallas, Texas, United States
Background
HCV nucleic acid testing (NAT) testing for deceased donors has become routine since April 2014. Comparative outcomes of deceased donor renal transplants (DDRT) based on HCV NAT and antibody (Ab) testing in different donor-recipient pairs are not well known.
Methods
We queried the UNOS dataset for DDRT performed between April 2015 and September 2017. Pediatric age, multiorgan transplants, and cases with unknown HCV NAT / Ab status were excluded. The final study cohort (N=27,930) were stratified into 4 groups: 1) Donor (D) Ab-/NAT- Recipient (R) Ab- (reference group, n=27,070); 2) D Ab+/NAT- R Ab- (n=133); 3) D Ab+ / NAT+ R Ab- (n=65); 4) D Ab+/NAT+ R Ab+ (n=662). A propensity score was calculated based on donor KDPI, recipient age, race, and underlying kidney diagnosis. An exact propensity score matching was performed 1:4 ratio between the reference group and other 3 stratified groups. Primary outcomes were overall allograft survival (failure defined as death or graft failure), acute rejection at 1 year and DGF.
Results
The results are shown in Table 1.
Conclusion
HCV NAT + kidneys do have similar outcomes compared to NAT negative donors. Utilization of HCV NAT + kidneys should be encouraged.
Characteristics and outcomes of DDRT based on HCV NAT and Ab testing
| DAb-/NAT- RAb- N=20,070 | DAb+/NAT- RAb- N=133 | D Ab+/NAT+ RAb- N=65 | D Ab+/NAT+ RAb+ N=662 | P-value 4-way | |
| Donor age, mean(SD) | 38.8 ±15.8 | 36.7±11.7 | 32.4±8.6 | 32.6±8.2 | <0.001 |
| Donor gender, male % | 61.4 | 48.9 | 61.5 | 67.8 | <0.001 |
| Donor race, White % | 67.6 | 90.2 | 92.3 | 84.3 | <0.001 |
| DCD donor % | 21.2 | 16.5 | 7.7 | 8.2 | <0.001 |
| ECD donor, % | 13.5 | 6 | 0 | 1.5 | <0.001 |
| KDPI, % | 47±26 | 57±19 | 49±15 | 49±16 | <0.001 |
| Recipient age, mean (SD) | 518±13.5 | 57.8±10.8 | 60.1±7.5 | 59.8±7.7 | <0.001 |
| Recipient gender, male % | 61.4 | 48.9 | 61.5 | 67.8 | <0.001 |
| Recipient race, White % | 36.8 | 37.6 | 47.7 | 26.1 | <0.001 |
| ESRD diagnosis, DM % | 26 | 33.8 | 36.9 | 39.4 | <0.001 |
| Dialysis duration>3 yr, % | 70.3 | 68.4 | 14.3 | 41 | <0.001 |
| Transplant factors and outcomes | |||||
| CIT, hr | 17.9±8.7 | 19.8±7.3 | 20.7±8.6 | 18.4±8 | <0.001 |
| National allocation, % | 16.3 | 60.2 | 55.4 | 48.8 | <0.001 |
| Length of stay, days | 6.4±7.2 | 6.1±5.1 | 6.4±5.7 | 6.1±4.9 | <0.001 |
| HLA mismatch >3, % | 71 | 81 | 73 | 83 | <0.001 |
| Acute rejection at one-year, % | 4.4 | 0 | 1.5 | 3.6 | <0.001 |
| Propensity matched overall graft survival at one year, % | 93.7 | 89.7 | 98.1 | 94 | <0.001 |
| DGF, % | 28.7 | 17.3 | 23.1 | 18.9 | <0.001 |