"It seems wasteful to discard these. There should be someone on the list who would benefit from them, even with higher infectious risk. The real diseases we worry about – HIV and HCV [hepatitis C virus] – take years for sequelae to develop," Dr. Segev said.
In two separate studies, the risk of infection from such an organ per 10,000 donors during the "window period" prior to positive test results for injection drug users was 4.9 for HIV and 32.4 for HCV. For MSM, those risks were 4.2 and 3.5, respectively, and for commercial sex workers, 2.7 and 12.3, respectively. The others incurred lower risks (Am. J. Transplant. 2011;1176-87; 11:1188-200).
New data from Dr. Segev’s group suggest that the risk of a poor outcome (defined as 33% or more of the year after the kidney transplantation that was spent hospitalized or dying) among older transplant recipients increases by an adjusted odds ratio of 1.42 per 10 years. Years on pretransplantation dialysis also was a significant predictor (1.11), whereas the receipt of a live donor organ was protective (0.59).
In all, the risks of kidney transplantation for older adults include the upfront risks of surgery, particularly among those with comorbidities; the risk of immunosuppression; and the ongoing need for medical follow-up. But the benefits can include longer survival and improved quality of life, Dr. Segev said.
Dr. Segev disclosed that he is a consultant, scientific advisor, and speaker for Sanofi.