D LEE1,2, N SENG3, I GRAMNEA3, F HUDSON4, R D’COSTA3, L MCEVOY3, J SASADEUSZ5, B GOPAL6, J KAUSMAN7, R MASTERSON8, K PAIZIS2, J KANELLIS9, P HUGHES8, D GOODMAN10, J WHITLAM2
1Department of Renal Medicine, Eastern Health Clinical School, Monash University, 2Department of Nephrology, Austin Health, 3DonateLife Victoria, 4Victorian Transplantation and Immunogenetics Service, Australian Red Cross Lifeblood, 5Department of Infectious Diseases, Royal Melbourne Hospital, 6Department of Renal Medicine, Alfred Hospital, 7Department of Nephrology, Royal Children’s Hospital, 8Department of Nephrology, Royal Melbourne Hospital, 9Department of Nephrology, Monash Health, 10Department of Nephrology, St Vincent’s Hospital Melbourne
Aims: To review the Victorian increased viral risk donor (IVRD) program 22 months post-implementation.
Background: 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 but were historically under-utilised. A new system of allocation of these donors (defined by Public Health Service (PHS) 2013 criteria and open window periods) to pre-consented recipients was developed.
Methods: We retrospectively examined the characteristics of IVRDs (31/07/2018-31/05/2020). Data for comparison with non-IVRDs was available for the first 7 months. Continuous data was expressed as median (IQR).
Results: 40% of waitlisted recipients were pre-consented to accept IVRD kidneys. 32 IVRDs (58 kidneys) were utilised, comprising 13.5% of all kidney donors. Only 9% of allocated IVRDs had neither kidney accepted. Injecting drug use (59%) was the commonest at-risk behaviour. NAT was performed 3 (2-4) days post-admission. 9 (28%) IVRDs had positive HCV Ab but negative NAT. 50% of recipients of these 9 IVRDs developed abnormal HCV serology, but no viraemia was detected in any IVRD recipients to date at 1 and 3 months post-transplantation. 3-month eGFR (CKD-EPI) was 65 (53-79) mL/min/1.73m2. Compared with non-IVRDs, IVRDs were younger (37 (30-44) versus 51 (35-61) years; P<0.01), with lower kidney donor profile index (KDPI) (26 (17-40) versus 59 (25-78); P<0.001), and none had a KDPI >80% (0% versus 19%; P<0.05). Waiting time was significantly shorter for blood group O IVRD versus non-IVRD recipients (26 (18-29) versus 38 (34-42) months; P=0.001).
Conclusion: IVRDs appear to offer better quality kidneys and may reduce waiting time with no transmission to date. Increasing the pre-consent rate may improve utilisation and benefit more waitlisted recipients.
Darren Lee is a transplant nephrologist at Eastern Health and Austin Health in Melbourne and an adjunct senior lecturer of Eastern Health Clinical School, Monash University. He is a member of the Victorian & Tasmanian Renal Transplant Advisory Committee and the Victorian Renal Clinical Network Governance Committee. He played a role in the implementation and the ongoing review of the Increased Viral Risk Donor kidney transplant waiting list in Victoria.