Despite the ongoing organ shortage, kidneys from CDC high risk donors (HR) are often declined for transplantation by transplant providers or recipients because of concern for risk of viral infection transmission. Methods: Retrospective, single-center review of 90 HR and 780 contemporaneous non-high risk (NHR) deceased donor kidney transplants from 1/30/06 – 12/2/11. All donors were serologically negative for HCV, HBV, and HIV. Nucleic acid testing was performed routinely after 6/1/09. Recipient serologies were monitored serially post-transplant. Whenever possible, HR kidneys were preferentially allocated to recipients with long anticipated waiting times and high mortality on dialysis. Results: No instances of seroconversion were observed during a median follow-up of 3.3 years (minimum 1 year follow-up). The most common reasons for donor designation as HR were history of IV drug use (35%), high risk partner (15%) and incarceration (12%). Compared with NHR donors, HR donors were younger (mean 36 years vs. 45 years, p<0.001) and were less likely to be ECD (10% vs. 31%, p=0.001). Compared with recipients of NHR kidneys, HR kidney recipients had similar waiting times (mean 21 months vs. 22 months, p=NS), longer dialysis duration (mean 4.4 years vs. 3.3 years, p=0.005), and lower serum creatinine at 2 years post-transplant (mean 1.5 mg/dl vs. 1.7 mg/dl, p=0.05). One- and 3-year graft survival were higher in HR compared to NHR recipients (97%, 95% vs. 91%, 83%, p=0.02). Patient survival was similar in both groups. Conclusions: HR kidneys can be transplanted with negligible viral infection transmission rates and excellent intermediate term outcomes. Despite terminology, HR donors may actually represent a low risk option for expanding the donor pool, especially considering the high morbidity and mortality associated with prolonged dialysis. Evidence based education of transplant candidates and medical professionals regarding actual donor and recipient risks is needed to promote optimal and appropriate use of HR kidneys.

« Back to 2013 American Transplant Congress