Estimated benefits of transplantation of kidneys from donors at increased risk for HIV or hepatitis C infection

E J Schweitzer; E N Perencevich; B Philosophe; S T Bartlett

doi:10.1111/j.1600-6143.2007.01769.x

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Estimated benefits of transplantation of kidneys from donors at increased risk for HIV or hepatitis C infection

Journal article

Open access

Peer reviewed

Estimated benefits of transplantation of kidneys from donors at increased risk for HIV or hepatitis C infection

E J Schweitzer, E N Perencevich, B Philosophe and S T Bartlett

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Vol.7(6), pp.1515-1525

06/2007

DOI: 10.1111/j.1600-6143.2007.01769.x

PMID: 17511680

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Abstract

Kidneys from organ donors who have behaviors that place them at increased risk for infection with human immunodeficiency virus (HIV) or hepatitis C virus (HCV) are often discarded, even if viral screening tests are negative. This study compared policies that would either 'Discard' or 'Transplant' kidneys from Centers for Disease Control classified increased-risk donors (CDC-IRDs) using a decision analytic Markov model of renal failure treatment modalities. Base-case CDC-IRDs were current injection drug users (IDUs) with negative antibody and nucleic acid testing (NAT) for HIV and HCV, comprising 5% of kidney donors. Compared to a CDC-IRD kidney 'Discard' policy, the 'Transplant' policy resulted in higher patient survival, a greater number of quality-adjusted life-years (QALYs) (5.6 vs. 5.1 years per patient), more kidney transplants (990 vs. 740 transplants per 1000 patients) and lower cost of care ($60 000 vs. $71 000 per QALY). The total number of viral infections was lower with the 'Transplant' policy (13.1 vs. 14.8 infections per 1000 patients over 20 years), because the 'Discard' policy led to more time on hemodialysis, with a higher HCV incidence. We recommend that kidneys from NAT-negative CDC-IRDs be considered for transplantation since the practice is estimated to be beneficial from both the societal and individual patient perspective.

Markov Chains

Kidney Failure, Chronic - surgery

Risk Assessment

HIV Infections - epidemiology

Humans

Treatment Outcome

Patient Selection

Kidney Failure, Chronic - therapy

Kidney Transplantation - physiology

Hepatitis C - epidemiology

Risk-Taking

Tissue Donors - statistics & numerical data

Kidney Transplantation - adverse effects

Renal Dialysis

HIV

Hepatitis C

Details

Title: Subtitle: Estimated benefits of transplantation of kidneys from donors at increased risk for HIV or hepatitis C infection
Creators: E J Schweitzer - Division of Transplantation, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD, USA. gschweitzer@smail.umaryland.edu
E N Perencevich
B Philosophe
S T Bartlett
Resource Type: Journal article
Publication Details: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Vol.7(6), pp.1515-1525
DOI: 10.1111/j.1600-6143.2007.01769.x
PMID: 17511680
NLM abbreviation: Am J Transplant
ISSN: 1600-6135
eISSN: 1600-6143
Publisher: United States
Language: English
Date published: 06/2007
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9983779492902771

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