Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Background: Due to a shortage of organ donors and increasing mortality on the wait list, marginal donors, including those at increased risk for blood borne pathogens, are increasingly used. Key to the safe use of organs from increased risk donors (IRD) is nucleic acid testing (NAT) of donors and recipients who receive these organs.
Objectives: To describe the IRDs accepted and follow up of recipients who received these organs at a large multi-organ transplant center in Canada from 2008 to August 2014.
Methods: A retrospective chart review and descriptive analysis was conducted on all IRDs and recipients of organs from these donors. All donors were screened by serology for HIV, HCV and HBV and NAT for HIV, HCV +/- HBV. Follow up serology and NAT testing on recipients were extracted from the Provincial Laboratory database.
Results: A total of 85 IRDs were initially accepted; 1 was excluded at procurement due to the presence of pancreatic cancer. The most common risk factor was injection drug use. All donors were HIV negative by serology and NAT, 4 were HCV antibody positive with 3 also NAT positive. All were HBsAg negative and 2 were anti-HBc positive. From the 84 donors utilized, there were 193 transplants including 61 kidney, 51 liver, 30 lung, 29 heart, 12 islets, 4 kidney-pancreas, 3 pancreas, and 1 each liver-kidney, small bowel and heart lung. All recipients were HIV negative with 28 HCVRNA and 2 HBsAg positive respectfully. HBV immunity was documented in 83. HIV NAT and HCV NAT follow up was documented in 104 (53.9%) and 119 (61.6%) recipients respectfully with a median time to first follow up testing of 88 days. Kidney recipients were more likely (65.6%) and liver recipients less likely (37.3%) to have follow up testing. Follow up HBsAg was done in 121 (62.7%). There was no significant change in follow up testing over time.
Conclusion: Use of IRDs has resulted in an additional 193 transplants over 6.5 years from donors that would have previously been declined. Follow up of recipients of IRDs however was inadequate, despite local and recent Canadian guidelines, and variable by organ group. To improve follow up testing and safe use of IRDs, additional interventions are needed and we are currently assessing a routine fax reminder to recipient programs.
To cite this abstract in AMA style:Doucette K, Worton K, Kutsogiannis J, Preiksaitis J. Utilization of Increased Risk Donors in a Canadian Multi-Organ Transplant Program [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/utilization-of-increased-risk-donors-in-a-canadian-multi-organ-transplant-program/. Accessed April 20, 2021.
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