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Turn down for what? Patient outcomes associated with declining increased infectious risk kidneys
Author(s) -
Bowring Mary G.,
Holscher Courtenay M.,
Zhou Sheng,
Massie Allan B.,
GaronzikWang Jacqueline,
Kucirka Lauren M.,
Gentry Sommer E.,
Segev Dorry L.
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14577
Subject(s) - medicine , interquartile range , hazard ratio , kidney , kidney disease , kidney transplantation , intensive care medicine , confidence interval
Transplant candidates who accept a kidney labeled increased risk for disease transmission (IRD) accept a low risk of window period infection, yet those who decline must wait for another offer that might harbor other risks or never even come. To characterize survival benefit of accepting IRD kidneys, we used 2010‐2014 Scientific Registry of Transplant Recipients data to identify 104 998 adult transplant candidates who were offered IRD kidneys that were eventually accepted by someone; the median (interquartile range) Kidney Donor Profile Index (KDPI) of these kidneys was 30 (16‐49). We followed patients from the offer decision until death or end‐of‐study. After 5 years, only 31.0% of candidates who declined IRDs later received non‐IRD deceased donor kidney transplants; the median KDPI of these non‐IRD kidneys was 52, compared to 21 of the IRDs they had declined. After a brief risk period in the first 30 days following IRD acceptance (adjusted hazard ratio [aHR] accept vs decline: 1.22 2.06 3.49 , P = .008) (absolute mortality 0.8% vs. 0.4%), those who accepted IRDs were at 33% lower risk of death 1‐6 months postdecision (aHR 0.50 0.67 0.90 , P = .006), and at 48% lower risk of death beyond 6 months postdecision (aHR 0.46 0.52 0.58 , P < .001). Accepting an IRD kidney was associated with substantial long‐term survival benefit; providers should consider this benefit when counseling patients on IRD offer acceptance.