High-Risk Kidney Transplants On The Rise As More CKD And Dialysis Patients Take Chance



A KidneyBuzz.com viewer asked, "'High-risk' kidneys, specifically previous HIV and Hepatitis infected donors: Do you have any professional info/experience with these type of cases? Success/ failure rates, longevity, complications,  etc. I would greatly appreciate the input. Thanks."

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With the Kidney Transplant List waiting times continually increasing (5 to 7 years on average nationally, and 7 to 10 years in some densely populated areas such as Los Angeles and New York), the opportunity for a deceased (dead) donor kidney is becoming more difficult. This is leading patients to consider higher risk alternatives. Deceased donor kidneys classified as "high-risk" are at an elevated risk of transmitting very serious infections such as Human Immunodeficiency Virus (HIV), Hepatitis C Virus, and Hepatitis B Virus to kidney transplant recipients. That is why it is shocking to learn that most Kidney Transplant Candidates would accept a high-risk transplant with little hesitation, according to the Clinical Journal of the American Society of Nephrology. The following are important and lesser known facts which patients can use to determine (1) if higher risk kidneys are right for them and (2) how they may be considered to help reduce their wait times:

1. Is a high-risk Kidney Transplant worth it? While getting a Kidney Transplant can significantly improve a person's quality of life, Dr. Robert Montgomery (Johns Hopkins School of Medicine) said that there is "very low risk of contracting a viral illness" from a high-risk Kidney Transplant. Hence, while the decision is clearly the patient's to make, if one is considering a riskier kidney then he/she must be prepared to accept the possible increased risks of acquiring HIV transmission and/or other diseases. This must be weighed against the fact that the wait list for kidney transplants is growing rapidly, and there are better treatments for blood-borne infections; as evidenced by patients who have these diseases enjoying superior results from Kidney Transplants compared to those remaining on Dialysis.

2. Do high-risk kidneys work well? Deceased donor kidneys that are high-risk for infection and disease transmission, functioned well after 2 years of follow-up, and had no evidence of harmful HIV antibodies.

3. How many high-risk kidneys are available for transplant? Most will be surprised to learn that nearly 10% of the overall pool of kidneys obtained from deceased donors are labeled, "high-risk." Dr. Montgomery suggested that, "Many high-quality organs are being discarded at a time when the nation has an acute shortage of donor kidneys and a high death rate among those on the transplant waiting list." He even suggested reclassifying some high-risk donors as "low-risk" based on types of disease.

4. What type of patient benefits the most from accepting a high-risk Kidney Transplant? Dr. Montgomery noted that he and his colleagues are still trying to determine the optimal equations for transplanting organs from high-risk donors into Chronic Kidney Disease patients. However, age may be an important factor. For instance, the risk of acquiring Hepatitis C is much different in a 70-year-old compared with a 30-year-old because many of the most severe manifestations of the disease may not occur for up to 20 years - well beyond the life expectancy of a 70-year-old kidney recipient. Also, patients who have been on the waiting list for longer than five years may be more inclined to consider a high-risk transplant than those who are newer to the waiting list.

5. How can a patient be considered for a high-risk Kidney Transplant? Kidney Transplant Teams are in a conundrum when it comes to using kidneys from donors who have a history of high-risk behavior for HIV, Hepatitis B, and Hepatitis C.  “Very often when you are on-call you are offered organs from young perfect donors who have had high-risk behavior,” Dr. Montgomery said. “It might be drug use or homosexuality or in the sex trade or something like that.” Chronic Kidney Disease and Dialysis patients who would like to be considered for a high-risk transplant should talk to their Kidney Transplant Team about the idea. Your Kidney Transplant Center can provide your with the appropriate information to have your name considered should a high-risk option become available.

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