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Published on: February 21, 2016
Identifying appropriate recipients for CDC infectious risk donor kidneys
E K H Chow1, A B Massie, A D Muzaale
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Summary
Kidney transplant recipients can benefit from infectious risk donors (IRDs). Patient characteristics determine if survival benefits outweigh infection risks from IRD kidneys, guiding better transplant decisions.
Area of Science:
- Transplantation immunology
- Medical decision making
- Public health
Background:
- In 2011, over 10% of deceased donors met infectious risk donor (IRD) criteria.
- Kidneys from IRDs have significantly higher discard rates.
- Patient survival benefit may outweigh infectious risk for certain phenotypes.
Purpose of the Study:
- To develop and validate a model predicting survival benefit from IRD kidneys.
- To identify patient phenotypes that benefit most from IRD kidney transplantation.
- To inform patient and provider decision-making regarding IRD offers.
Main Methods:
- A patient-oriented Markov decision process model was developed and validated.
- Model used data from the Scientific Registry of Transplant Recipients (SRTR).
- Incorporated meta-analyses of window period risks for IRD behaviors.
Main Results:
- Estimated 5-year survival differences with IRD acceptance ranged from -6.4% to +67.3%.
- Key predictive factors included patient age, PRA, previous transplant history, and time to next offer.
- Survival benefit from IRD kidneys varies widely based on patient phenotype.
Conclusions:
- It is possible to identify patients who are predicted to benefit from IRD kidneys.
- Model-based predictions can inform clinical decisions for IRD kidney offers.
- Estimated survival curves can enhance shared decision-making between patients and providers.
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