*Purpose: With the growing opioid crisis, the number of deceased donors classified as Increased Risk Donor (IRD) has increased to nearly 20% nationally. The Organ Procurement and Transplantation Network (OPTN) mandates that recipients of these organs have post-transplant testing for HBV, HCV, and HIV. The purpose of this study is to determine compliance with post-transplant viral load surveillance of patients receiving abdominal organ transplants from IRD donors.

*Methods: This is a retrospective single center cohort study of abdominal organ transplant patients receiving IRD donor organs from January 2015 through December 2018. Per protocol, patients should have HBV, HCV, and HIV PCR performed at months (M) 1, 3, 6 and 12 post-transplant. The primary end-point is overall compliance with viral monitoring. Secondary end-points include patients who had no monitoring and disease transmission. Simultaneous kidney pancreas recipients were considered included in the kidney cohort and simultaneous liver-kidney were included in liver cohort.

*Results: There were 95 transplant patients (51 kidneys, 44 livers) who received IRD organs during the study period, representing 20% of liver and 16% of kidney organs transplanted during that period. Overall HIV compliance at months 1, 3, 6, and 12 were: 55%, 62%, 68%, and 68%. HBV compliance rates were similar: 48%, 68%, 69%, and 72%. Finally, HCV screening rates were: 54%, 68%, 72%, and 72%. There was trend for M1 to be consistently lower rates than M12 for all viruses (HBV:51% vs. 72%; p=0.07), (HCV: 46% vs. 76%; p=0.06), (HBV: 54% vs. 72%;p=0.073) HIV compliance rates were significantly higher in kidney cohort compared to liver recipients at all time points: m1 (73% vs 34%; p=0.002), m3 (84% vs. 42%; p=0.0001), m6 (86% vs. 55%; p=0.0001), and m12 (86% vs. 55%; p=0.0001). HBV and HCV monitoring rates were similarly higher in kidney patients compared to liver cohort with equivalent rates (data not shown). Importantly, there were zero cases of donor to recipient viral transmission regardless of organ type. There was one case of HCV reactivation which presented at six months post-transplant. Most concerning, there was nearly 10% of patients who failed to receive any testing at all (HIV: 13%, HBV: 7%, and HCV: 6%). Once again, these rates were higher in liver patients for HIV (4% vs. 20%; p=0.01) and HBV (2% vs 14%; p=0.046).

*Conclusions: The data would suggest that there are clearly opportunities for improvement through development of standardized work at a transplant center level, visual management systems, and “Best Practice Alerts” within electronic medical records. With the increasing use of IRD organs and emerging use of actively infected organs into naïve patients, there is increased need for transplant centers to develop and adhere to vigilant viral screening protocols with dire consequences in their absence.

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