DECISION SUPPORT TOOL FOR ASSESSING ABSOLUTE RISK OF CANCER TRANSMISSION FROM DECEASED KIDNEY DONORS
James Hedley1, Pinika Patel1, Angela Webster1,2,3 1Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia2National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia3Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
Abstract
Background
Kidneys from deceased donors with history of cancer are often declined for donation due to perceived cancer transmission risk, despite being acceptable under clinical guidelines. These donors are often optimal donation candidates apart from their cancer history, and the absolute risk of graft failure for recipients of their kidneys may be similar to other donor kidneys without cancer history.
Aim
We aimed to develop an evidence-based decision support tool to assist donation specialists in deciding whether to accept or decline a kidney from a deceased donor with cancer history.
Methods
We used linked data from ANZDATA to model absolute rates of kidney graft survival based on donor age, sex, blood group, height, weight, pathway, dual allocation, hypertension, diabetes, stroke, and creatinine. We excluded multi-organ and subsequent transplants, and did not consider recipient characteristics as these would not be known at the time of initial donation decisions. Time to graft failure was modelled using a spline with knots at 1 day and median log survival time. Cancer transmission was conservatively assumed to always result in nephrectomy. The decision support tool was developed using the R package ‘shiny’.
Results
The decision support tool allows users to input characteristics and cancer details of a potential deceased donor being considered for kidney donation, as well as for a hypothetical comparison donor (e.g., a previously accepted donor). Outcomes are presented in terms of absolute risk of graft survival after 1 or 5 years (Figure 1).
Conclusions
Evidenced based absolute risk of transmission may support increased donation from donors with a cancer history, in line with existing clinical guidelines, and improve donation specialists’ confidence in their decisions.
Biography
James has recently completed his PhD at the University of Sydney which focused on strategies to increase utilisation of organs for transplantation from donors with history of cancer. He is a biostatistician and health economist, and has previous experience working as a data manager at Murdoch Children’s Research Institute and in the pharmaceutical industry.