PURPOSE: According to the Italian Guidelines for organ donors safety, deceased donors with a recent (≤ 2 weeks) risky behaviour for acqusition of HIV, HBV or HCV are classified as “increased infectious risk donors” (IRD). Organs from IRD are offered to recipients who have signed a specific informed consent at the time of listing and again before transplantation. Purpose of this study is to assess the safety and the clinical outcome associated with organ transplantation from IRD. METHODS: We retrospectively identified all IRD and their recipients transplanted from 2006 to 2011 in the Nord Italia Transplant program (NITp) area. The dataset for each recipient included baseline and monthly serologic and NAT testing for HIV, HBV, HCV and syphilis, and patient and graft survival at 6 and 12 months. RESULTS: 86 IRD (71 male, mean age 37 years, range 15-67) were identified. They were classified as IRD because of illicit drug use (43%), promiscuous sexual behaviours (16.3%), recent or current incarceration, limited or missing anamnestic informations (11.6%), or any combinations of these factors (29%). Organs from IRD have been transplanted in 174 recipients (85 kidney, 43 liver, 35 heart, 7 lung, 2 kidney-pancreas, 1 heart-kidney, 1 pancreas) with a 1-year survival rate of 93.1%. We have currently collected complete follow-up data of 63/174 recipients (36.2%), as detailed in table 1.

During a mean follow-up of 10.5 months (range 0.5-12) no transmissions of HIV, HBV, HCV, or syphilis has been documented by serology and NAT-testing. The data collection is still ongoing and we are confident to be able to complete the analysis of the entire population in the next few weeks. CONCLUSIONS: At the perliminary analysis the use of organs from IRD was associated with a safe increase of the transplant procedures in our Country. However, a careful donor risk-assessment, including NAT testing for HIV, HBV and HCV, and a close follow-up of the recipients is highly recommended.

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