T1. Studies of pre-transplant screening and evaluation
Oral Abstract Submission
Lara Danziger-Isakov, MD, MPH
Professor of Pediatrics
Cincinnati Children's Hospital Medical Center
Disclosure: Ansun: Research Grant
Astellas: Grant/Research Support
GlaxoSmithKline: Advisory Board
Merck: Consultant, Grant/Research Support
Shire: Grant/Research Support
Viracor: Grant/Research Support
In the U.S. all deceased donors (DD) are evaluated for behavioral risk factors for human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) infection during the past 12 months. DD with behavioral risk factors or hemodilution are designated as PHS increased risk donors (IRD). Since 2013, the number of IRD has increased from 13.4% of DD to 27% in 2018. Despite a low residual risk of disease transmission after a negative nucleic acid test for HIV/HBV/HCV, the considerable underutilization of IRD has driven an interest in revising the PHS IRD 2013 guidelines. The objective of this study was to describe the epidemiology of IRD with the goal of guiding policy change and maximize organ use.
Retrospective cohort study of DD during 2018. Characteristics of IRD were compared to non-IRD. A random 10% sample of IRD was selected for manual review of text narratives and donor questionnaires submitted by organ procurement organizations to determine specific PHS IRD factors. Categorical variables were compared using the Chi-square test and continuous variables were compared using a 2-sample t-test for independent samples.
Among 10,721 DD in 2018, 2,904 were designated IRD (27.1%) with regional variability noted (Fig). Compared to non-IRD, IRD were younger (median age 35 vs 45 years, p < 0.001) and more often died from drug intoxication (33.2 vs 5.6% p < 0.001). Hemodilution was found in 6.8% of all IRD and was the only factor for IRD designation in 60% of pediatric donors < 12 years old. The random sample of IRD (N=288) was similar to IRD population for age, gender, ethnicity, cause of death, and region of recovery (Table). Descriptive analysis of the random sample showed that intravenous drug use was the most common behavioral risk factor (N = 124, 43.1%), followed by incarceration (N = 108, 37.5%). Most DD met only 1 criterion (N = 179, 62%); 21% met 2 criteria; and 17% had >3 criteria.
This study represents the most detailed description of PHS IRD factors since the adoption of the new guidelines in 2013. Understanding the prevalence of factors that lead to IRD designation will help inform future policy development, optimize safe DD use, and increase the number of transplants.