Observational Study Examining Kidney Transplantation Outcomes Following Donation From Individuals That Died of Drug Toxicity in British Columbia, Canada
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Published on: June 17, 2020
Max Wenheng Xie1, Sean Patrick Kennan2,3, Amanda Slaunwhite1,3
1BC Centre for Disease Control, Vancouver, Canada.
Background:
The illicit drug toxicity (overdose) crisis has worsened across Canada, between 2016 and 2021 more than 28 000 individuals have died of drug toxicity. Organ donation from persons who experience drug toxicity death has increased in recent years.
Objective:
This study examines whether graft loss after kidney transplantation differed by donor cause of death.
Design:
Retrospective cohort.
Setting:
Provincial transplant program of British Columbia, Canada.
Patients:
Transplant recipients who received kidney transplantation from deceased donors aged 12 to 70 years between 2013 and 2019 (N = 1012).
Measurements:
Transplant recipient all cause graft loss (graft loss due to any cause including death) was compared by donor cause of death from drug toxicity or other.
Methods:
Five-year Kaplan-Meier estimates of all-cause graft survival, and 3-year complete as well as stratified inverse probability of treatment weighted Cox proportional hazards models were conducted.
Results:
Drug toxicity death donors donated to 25% (252/1012) of kidney transplantations. Drug toxicity death donors were more likely to be young, white, males, with fewer comorbidities such as diabetes or hypertension but were more likely to have a terminal serum creatinine ≥1.5 mg/dL or be hepatitis C virus (HCV) positive. Unadjusted 5-year estimate of all-cause graft survival was 97% for recipients of drug toxicity donor kidneys and 83% for recipients of non-drug toxicity donor kidneys (P < .001). Recipients of drug toxicity death donor kidneys had decreased risk of all cause graft loss compared to recipients of non-drug toxicity death donor kidneys (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.12-0.77, P = .012). This is primarily due to the reduced risk of all-cause graft loss for recipients of younger (≤35 years) drug toxicity death donor kidneys (HR: 0.05, 95% CI: 0.00-0.55, P = .015).
Limitations:
Potential selection bias, potential unmeasured confounding.
Conclusions:
Donation after drug toxicity death is safe and should be considered more broadly to increase deceased donor kidney donation.
Insights
Kidney transplants from deceased donors who died of drug toxicity show improved graft survival rates. This indicates that donation after drug toxicity death is safe and can expand deceased donor kidney availability.
Area of Science:
- Nephrology
- Transplantation Immunology
- Public Health
Background:
- Canada faces a severe illicit drug toxicity (overdose) crisis, with over 28,000 deaths between 2016 and 2021.
- Organ donation from individuals experiencing drug toxicity death has increased.
- Kidney transplantation outcomes based on donor cause of death require examination.
Purpose of the Study:
- To investigate if graft loss after kidney transplantation differs based on the donor's cause of death.
- To compare all-cause graft loss in kidney transplant recipients based on whether the donor died from drug toxicity or another cause.
Main Methods:
- Retrospective cohort study of 1012 kidney transplant recipients in British Columbia, Canada (2013-2019).
- Analysis of graft loss compared between donors who died of drug toxicity versus other causes.
- Utilized Kaplan-Meier estimates for 5-year all-cause graft survival and Cox proportional hazards models for risk assessment.
Main Results:
- Kidney transplants from drug toxicity donors accounted for 25% of cases and were associated with younger, healthier profiles, though higher creatinine and HCV positivity were noted.
- Unadjusted 5-year all-cause graft survival was significantly higher for recipients of drug toxicity donor kidneys (97%) compared to non-drug toxicity donors (83%).
- Recipients of drug toxicity donor kidneys demonstrated a reduced risk of all-cause graft loss (HR: 0.30), particularly those receiving kidneys from younger donors (≤35 years, HR: 0.05).
Conclusions:
- Donation following drug toxicity death is a safe and viable option for increasing deceased donor kidney supply.
- The findings support broader consideration of donation after drug toxicity death to enhance kidney transplantation programs.
- This strategy can potentially improve long-term graft survival outcomes for kidney transplant recipients.
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