Successful implementation of increased viral risk donor waiting list for preconsented waitlisted recipients in victoria.

Abstract

Aims: To review the Victorian increased viral risk donor (IVRD) program 22 months post-implementation. Background(s): IVRDs with at-risk behaviours for blood borne virus infection and negative nucleic acid testing (NAT) have a low absolute risk of window period infection but were historically under-utilised. A new system of allocation of these donors (defined by Public Health Service [PHS] 2013 criteria and open window periods) to pre-consented recipients was developed. Method(s): We retrospectively examined the characteristics of IVRDs (July 31 2018-May 31, 2020). Data for comparison with non-IVRDs was available for the first 7 months. Continuous data was expressed as median (IQR). Result(s): 40% of waitlisted recipients were pre-consented to accept IVRD kidneys. Thirty-two IVRDs (58 kidneys) were utilised, comprising 13.5% of all kidney donors. Only 9% of allocated IVRDs had neither kidney accepted. Injecting drug use (59%) was the commonest at-risk behaviour. NAT was performed 3 (2-4) days post-admission. 9 (28%) IVRDs had positive HCV Ab but negative NAT. 50% of recipients of these 9 IVRDs developed abnormal HCV serology, but no viraemia was detected in any IVRD recipients to date at 1 and 3 months post-transplantation. 3-month eGFR (CKD-EPI) was 65 (53-79) mL/min/1.73 m2. Compared with non-IVRDs, IVRDs were younger (37 (30-44) vs 51 (35-61) years; P < 0.01), with lower kidney donor profile index (KDPI) (26 (17-40) vs 59 (25-78); P < 0.001), and none had a KDPI >80% (0% vs 19%; P < 0.05). Waiting time was significantly shorter for blood group O IVRD vs non-IVRD recipients (26 (18-29) vs 38 (34-42) months; P = 0.001). Conclusion(s): IVRDs appear to offer better quality kidneys and may reduce waiting time with no transmission to date. Increasing the pre-consent rate may improve utilisation and benefit more waitlisted recipients.