title: Longer-term outcomes after kidney transplantation from seronegative deceased donors at increased risk for blood-borne viral infection.
abstract: BACKGROUND
  Transmission of human immunodeficiency virus and hepatitis C to transplant recipients has drawn attention of the use of allografts from seronegative donors at increased risk for blood-borne viral infection (DIRVI).
  
  
  METHODS
  We performed a cohort study of 7803 kidney transplant recipients whose kidneys were recovered through one of two organ procurement organizations from 1996 to 2007. Detailed organ procurement organization data on donor risk factors were linked to recipient data from the Organ Procurement and Transplantation Network.
  
  
  RESULTS
  Median recipient follow-up was 3.9 years. Three hundred sixty-eight (5%) patients received DIRVI kidneys, a third of which were procured from donors with a history of injection drug use or commercial sex work. Compared with standard criteria kidney recipients, DIRVI kidney recipients were more likely to be human immunodeficiency virus positive or black. In multivariable Cox regression, using DIRVI recipients as the reference, recipients of standard criteria donor kidneys had lower mortality (hazard ratio [HR] 0.71, P<0.01) and no difference in death-censored allograft failure (HR 1.09, P=0.62), whereas recipients of expanded criteria donor kidneys had no significant difference in mortality (HR 0.98, P=0.83) but a higher allograft failure rate (HR 1.93, P<0.01). High-quality data on posttransplant recipient viral testing were not available.
  
  
  CONCLUSIONS
  DIRVI kidney recipients experienced higher mortality than standard criteria kidney recipients. This finding could be explained if sicker patients received DIRVI kidneys (i.e., residual confounding) or the less likely possibility of undetected transmission of viral infections. Given the limitations of registry data used in this analysis, prospective studies are needed to further elucidate these findings.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104-6021, USA. peter.reese@uphs.upenn.edu
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.forename: Scott D
authors.initials: SD
authors.lastname: Halpern
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
authors.forename: Roy
authors.initials: R
authors.lastname: Bloom
authors.forename: Howard
authors.initials: H
authors.lastname: Nathan
authors.forename: Richard
authors.initials: R
authors.lastname: Hasz
authors.forename: Joseph
authors.initials: J
authors.lastname: Roth
authors.forename: William
authors.initials: W
authors.lastname: Reitsma
authors.forename: Louis
authors.initials: L
authors.lastname: Krefski
authors.forename: Fred
authors.initials: F
authors.lastname: Goerlitz
authors.forename: Gina
authors.initials: G
authors.lastname: DeLauro
authors.forename: Emily
authors.initials: E
authors.lastname: Blumberg
authors.forename: Francis L
authors.initials: FL
authors.lastname: Weng
authors.forename: Arthur
authors.initials: A
authors.lastname: Caplan
authors.forename: Arwin
authors.initials: A
authors.lastname: Thomasson
authors.forename: Justine
authors.initials: J
authors.lastname: Shults
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
mesh_terms: D000328:Adult; D003643:Death; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014766:Viremia / Q000209:etiology*; D014777:Virus Diseases / Q000097:blood / Q000209:etiology*