title: Outcomes of renal transplants from Centers for Disease Control and Prevention high-risk donors with prospective recipient viral testing: a single-center experience.
abstract: OBJECTIVE
  The use of kidneys from deceased donors considered at increased infectious risk represents a strategy to increase the donor pool.
  
  
  METHODS
  Single-institution longitudinal observational study.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Fifty patients who gave special informed consent to receive Centers for Disease Control and Prevention high-risk (CDCHR) donor kidneys were followed up by serial testing for viral transmission after transplantation. Nucleic acid testing for human immunodeficiency virus, hepatitis B virus, and hepatitis C virus was performed on all high-risk donors before transplantation. Outcomes of CDCHR kidney recipients were compared with outcomes of non-high-risk (non-HR) kidney recipients.
  
  
  METHODS
  New viral transmission, graft function, and waiting list time.
  
  
  RESULTS
  No recipient seroconversion was detected during a median follow-up period of 11.3 months. Compared with non-HR donors, CDCHR donors were younger (mean [SD] age, 35 [11] vs 43 [18] years, P = .01), fewer were expanded criteria donors (2.0% vs 24.8%, P < .001), and fewer had a terminal creatinine level exceeding 2.5 mg/dL (4.0% vs 8.8%, P = .002). The median creatinine levels at 1 year after transplantation were 1.4 (interquartile range, 1.2-1.7) mg/dL for CDCHR recipients and 1.4 (interquartile range, 1.1-1.9) mg/dL for non-HR recipients (P = .4). Willingness to accept a CDCHR kidney significantly shortened the median waiting list time (274 vs 736 days, P < .001).
  
  
  CONCLUSIONS
  We show safe use of CDCHR donor kidneys and good 1-year graft function. With continued use of these organs and careful follow-up care, we will be better able to gauge donor risk and match it to recipient need to expand the donor pool and optimize patient benefit.
authors: Division of Transplant Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors: Bonnie E
authors: BE
authors: Lonze
authors: Nabil N
authors: NN
authors: Dagher
authors: Minghao
authors: M
authors: Liu
authors: Lauren M
authors: LM
authors: Kucirka
authors: Christopher E
authors: CE
authors: Simpkins
authors: Jayme E
authors: JE
authors: Locke
authors: Niraj M
authors: NM
authors: Desai
authors: Andrew M
authors: AM
authors: Cameron
authors: Robert A
authors: RA
authors: Montgomery
authors: Dorry L
authors: DL
authors: Segev
authors: Andrew L
authors: AL
authors: Singer
mesh_terms: D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D002487:Centers for Disease Control and Prevention, U.S.; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D014481:United States; D014777:Virus Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission; D014850:Waiting Lists
chemical_list: D004279:DNA, Viral