Successful implementation of increased viral risk donor waiting list for preconsented waitlisted recipients in Victoria

Darren Lee; Nina Seng; Indra Gramnea; Fiona Hudson; Rohit L. D'Costa; Leanne McEvoy; Joe John Sasadeusz; Gopal Basu; Joshua Y. Kausman; Rosemary Masterson; Kathy Paizis; John Kanellis; Peter Hughes; David Josef Goodman; John B. Whitlam

doi:10.1111/nep.13797

Successful implementation of increased viral risk donor waiting list for preconsented waitlisted recipients in Victoria

Darren Lee, Nina Seng, Indra Gramnea, Fiona Hudson, Rohit L. D'Costa, Leanne McEvoy, Joe John Sasadeusz, Gopal Basu, Joshua Y. Kausman, Rosemary Masterson, Kathy Paizis, John Kanellis, Peter Hughes, David Josef Goodman, John B. Whitlam

Eastern Health Clinical School

Research output: Contribution to journal › Meeting Abstract › peer-review

Abstract

Aims: To review the Victorian increased viral risk donor (IVRD) program 22 months post-implementation. Background: IVRDs with at-risk behaviours for blood borne virus infection and negative nucleic acid testing (NAT) have a low absolute risk of window period infection but were historically under-utilised. A new system of allocation of these donors (defined by Public Health Service (PHS) 2013 criteria and open window periods) to pre-consented recipients was developed. Methods: We retrospectively examined the characteristics of IVRDs (31/07/2018-31/05/2020). Data for comparison with non-IVRDs was available for the first 7 months. Continuous data was expressed as median (IQR). Results: 40% of waitlisted recipients were pre-consented to accept IVRD kidneys. 32 IVRDs (58 kidneys) were utilised, comprising 13.5% of all kidney donors. Only 9% of allocated IVRDs had neither kidney accepted. Injecting drug use (59%) was the commonest at-risk behaviour. NAT was performed 3 (2-4) days post-admission. 9 (28%) IVRDs had positive HCV Ab but negative NAT. 50% of recipients of these 9 IVRDs developed abnormal HCV serology, but no viraemia was detected in any IVRD recipients to date at 1 and 3 months post-transplantation. 3-month eGFR (CKD-EPI) was 65 (53-79) mL/min/1.73m2. Compared with non-IVRDs, IVRDs were younger (37 (30-44) versus 51 (35-61) years; P<0.01), with lower kidney donor profile index (KDPI) (26 (17-40) versus 59 (25-78); P<0.001), and none had a KDPI >80% (0% versus 19%; P<0.05). Waiting time was significantly shorter for blood group O IVRD versus non-IVRD recipients (26 (18-29) versus 38 (34-42) months; P=0.001). Conclusion: IVRDs appear to offer better quality kidneys and may reduce waiting time with no transmission to date. Increasing the pre-consent rate may improve utilisation and benefit more waitlisted recipients.

Original language	English
Pages (from-to)	12
Number of pages	1
Journal	Nephrology
Volume	25
Issue number	S3
DOIs	https://doi.org/10.1111/nep.13797
Publication status	Published - Nov 2020
Event	Annual Scientific Meeting of the Australian-and-New-Zealand-Society-of-Nephrology 2021 - Online, Adelaide, Australia Duration: 30 Nov 2021 → 2 Dec 2021 Conference number: 55th

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10.1111/nep.13797

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Cite this

Lee, D., Seng, N., Gramnea, I., Hudson, F., D'Costa, R. L., McEvoy, L., Sasadeusz, J. J., Basu, G., Kausman, J. Y., Masterson, R., Paizis, K., Kanellis, J., Hughes, P., Goodman, D. J., & Whitlam, J. B. (2020). Successful implementation of increased viral risk donor waiting list for preconsented waitlisted recipients in Victoria. Nephrology, 25(S3), 12. https://doi.org/10.1111/nep.13797

@article{b640903218f14b468bef32e8ed5d63eb,

title = "Successful implementation of increased viral risk donor waiting list for preconsented waitlisted recipients in Victoria",

abstract = "Aims: To review the Victorian increased viral risk donor (IVRD) program 22 months post-implementation. Background: IVRDs with at-risk behaviours for blood borne virus infection and negative nucleic acid testing (NAT) have a low absolute risk of window period infection but were historically under-utilised. A new system of allocation of these donors (defined by Public Health Service (PHS) 2013 criteria and open window periods) to pre-consented recipients was developed. Methods: We retrospectively examined the characteristics of IVRDs (31/07/2018-31/05/2020). Data for comparison with non-IVRDs was available for the first 7 months. Continuous data was expressed as median (IQR). Results: 40% of waitlisted recipients were pre-consented to accept IVRD kidneys. 32 IVRDs (58 kidneys) were utilised, comprising 13.5% of all kidney donors. Only 9% of allocated IVRDs had neither kidney accepted. Injecting drug use (59%) was the commonest at-risk behaviour. NAT was performed 3 (2-4) days post-admission. 9 (28%) IVRDs had positive HCV Ab but negative NAT. 50% of recipients of these 9 IVRDs developed abnormal HCV serology, but no viraemia was detected in any IVRD recipients to date at 1 and 3 months post-transplantation. 3-month eGFR (CKD-EPI) was 65 (53-79) mL/min/1.73m2. Compared with non-IVRDs, IVRDs were younger (37 (30-44) versus 51 (35-61) years; P<0.01), with lower kidney donor profile index (KDPI) (26 (17-40) versus 59 (25-78); P<0.001), and none had a KDPI >80% (0% versus 19%; P<0.05). Waiting time was significantly shorter for blood group O IVRD versus non-IVRD recipients (26 (18-29) versus 38 (34-42) months; P=0.001). Conclusion: IVRDs appear to offer better quality kidneys and may reduce waiting time with no transmission to date. Increasing the pre-consent rate may improve utilisation and benefit more waitlisted recipients.",

author = "Darren Lee and Nina Seng and Indra Gramnea and Fiona Hudson and D'Costa, {Rohit L.} and Leanne McEvoy and Sasadeusz, {Joe John} and Gopal Basu and Kausman, {Joshua Y.} and Rosemary Masterson and Kathy Paizis and John Kanellis and Peter Hughes and Goodman, {David Josef} and Whitlam, {John B.}",

year = "2020",

month = nov,

doi = "10.1111/nep.13797",

language = "English",

volume = "25",

pages = "12",

journal = "Nephrology",

issn = "1320-5358",

publisher = "Wiley-Blackwell",

number = "S3",

note = "Annual Scientific Meeting of the Australian-and-New-Zealand-Society-of-Nephrology 2021, ANZSN 2021 ; Conference date: 30-11-2021 Through 02-12-2021",

}

Lee, D, Seng, N, Gramnea, I, Hudson, F, D'Costa, RL, McEvoy, L, Sasadeusz, JJ, Basu, G, Kausman, JY, Masterson, R, Paizis, K, Kanellis, J, Hughes, P, Goodman, DJ & Whitlam, JB 2020, 'Successful implementation of increased viral risk donor waiting list for preconsented waitlisted recipients in Victoria', Nephrology, vol. 25, no. S3, pp. 12. https://doi.org/10.1111/nep.13797

TY - JOUR

T1 - Successful implementation of increased viral risk donor waiting list for preconsented waitlisted recipients in Victoria

AU - Lee, Darren

AU - Seng, Nina

AU - Gramnea, Indra

AU - Hudson, Fiona

AU - D'Costa, Rohit L.

AU - McEvoy, Leanne

AU - Sasadeusz, Joe John

AU - Basu, Gopal

AU - Kausman, Joshua Y.

AU - Masterson, Rosemary

AU - Paizis, Kathy

AU - Kanellis, John

AU - Hughes, Peter

AU - Goodman, David Josef

AU - Whitlam, John B.

N1 - Conference code: 55th

PY - 2020/11

Y1 - 2020/11

N2 - Aims: To review the Victorian increased viral risk donor (IVRD) program 22 months post-implementation. Background: IVRDs with at-risk behaviours for blood borne virus infection and negative nucleic acid testing (NAT) have a low absolute risk of window period infection but were historically under-utilised. A new system of allocation of these donors (defined by Public Health Service (PHS) 2013 criteria and open window periods) to pre-consented recipients was developed. Methods: We retrospectively examined the characteristics of IVRDs (31/07/2018-31/05/2020). Data for comparison with non-IVRDs was available for the first 7 months. Continuous data was expressed as median (IQR). Results: 40% of waitlisted recipients were pre-consented to accept IVRD kidneys. 32 IVRDs (58 kidneys) were utilised, comprising 13.5% of all kidney donors. Only 9% of allocated IVRDs had neither kidney accepted. Injecting drug use (59%) was the commonest at-risk behaviour. NAT was performed 3 (2-4) days post-admission. 9 (28%) IVRDs had positive HCV Ab but negative NAT. 50% of recipients of these 9 IVRDs developed abnormal HCV serology, but no viraemia was detected in any IVRD recipients to date at 1 and 3 months post-transplantation. 3-month eGFR (CKD-EPI) was 65 (53-79) mL/min/1.73m2. Compared with non-IVRDs, IVRDs were younger (37 (30-44) versus 51 (35-61) years; P<0.01), with lower kidney donor profile index (KDPI) (26 (17-40) versus 59 (25-78); P<0.001), and none had a KDPI >80% (0% versus 19%; P<0.05). Waiting time was significantly shorter for blood group O IVRD versus non-IVRD recipients (26 (18-29) versus 38 (34-42) months; P=0.001). Conclusion: IVRDs appear to offer better quality kidneys and may reduce waiting time with no transmission to date. Increasing the pre-consent rate may improve utilisation and benefit more waitlisted recipients.

AB - Aims: To review the Victorian increased viral risk donor (IVRD) program 22 months post-implementation. Background: IVRDs with at-risk behaviours for blood borne virus infection and negative nucleic acid testing (NAT) have a low absolute risk of window period infection but were historically under-utilised. A new system of allocation of these donors (defined by Public Health Service (PHS) 2013 criteria and open window periods) to pre-consented recipients was developed. Methods: We retrospectively examined the characteristics of IVRDs (31/07/2018-31/05/2020). Data for comparison with non-IVRDs was available for the first 7 months. Continuous data was expressed as median (IQR). Results: 40% of waitlisted recipients were pre-consented to accept IVRD kidneys. 32 IVRDs (58 kidneys) were utilised, comprising 13.5% of all kidney donors. Only 9% of allocated IVRDs had neither kidney accepted. Injecting drug use (59%) was the commonest at-risk behaviour. NAT was performed 3 (2-4) days post-admission. 9 (28%) IVRDs had positive HCV Ab but negative NAT. 50% of recipients of these 9 IVRDs developed abnormal HCV serology, but no viraemia was detected in any IVRD recipients to date at 1 and 3 months post-transplantation. 3-month eGFR (CKD-EPI) was 65 (53-79) mL/min/1.73m2. Compared with non-IVRDs, IVRDs were younger (37 (30-44) versus 51 (35-61) years; P<0.01), with lower kidney donor profile index (KDPI) (26 (17-40) versus 59 (25-78); P<0.001), and none had a KDPI >80% (0% versus 19%; P<0.05). Waiting time was significantly shorter for blood group O IVRD versus non-IVRD recipients (26 (18-29) versus 38 (34-42) months; P=0.001). Conclusion: IVRDs appear to offer better quality kidneys and may reduce waiting time with no transmission to date. Increasing the pre-consent rate may improve utilisation and benefit more waitlisted recipients.

U2 - 10.1111/nep.13797

DO - 10.1111/nep.13797

M3 - Meeting Abstract

SN - 1320-5358

VL - 25

SP - 12

JO - Nephrology

JF - Nephrology

IS - S3

T2 - Annual Scientific Meeting of the Australian-and-New-Zealand-Society-of-Nephrology 2021

Y2 - 30 November 2021 through 2 December 2021

ER -