Utilization of Hepatitis B viremic donors (NAT+) leads to improved kidney transplant access for older adult recipients with little to no wait time.

BACKGROUND: Though the use of Hepatitis B viremic (HBV) donor kidneys may be a safe alternative to improve access to transplantation, there has not been wide acceptance of this practice. In this study, we determined the safety and effectiveness of HBV NAT (+) donor kidneys in a protocolized manner in an older adult population. METHODS: Over a 3-year period, 16 decreased donor kidney transplants were performed with HBV NAT+ kidneys. Recipients of HBV NAT+ kidneys were treated with entecavir started pre-operatively and continued for 52 weeks. RESULTS: HBV NAT+ kidneys were preferentially used in older (68 ± 5 vs. 64 ± 9 years; p = .01) recipients with less dialysis time (93.8% < 5 years vs. 67% <5 years; p = .03). In this cohort, 3/16 had detectable HBV PCR 1-week post-transplant, but all were negative at 9- and 12-months. Calculated estimated glomerular filtration rate (eGFR) was slightly decreased 12-months post-transplant. Post-transplant outcomes in an age-matched cohort showed no difference in rates of delayed graft function, readmission within 30 days, and graft loss or death within 6 months of transplant (p > .05). CONCLUSION: Transplants with HBV NAT+ donor kidneys in a pre-emptive treatment protocol allow for increased safe access to transplantation in older adult recipients with little or no dialysis time.

U.S. Organ Transplantation System - Its History, Present, and Future.

The U.S. Organ Transplantation System is administered by the Health Resources and Services Administration, a division of the U.S. Department of Health and Human Services, and is contracted with the United Network for Organ Sharing (UNOS) to maintain the Organ Procurement and Transplant Network (OPTN). It is a very complex system whose goals are to ensure effectiveness, efficiency, and equity of organ sharing in the national system of organ allocation, as well as to increase the supply of donated organs available for transplantation. UNOS has been the only agency contracted by the OPTN since 1987. The OPTN has proposed changes to modernize and revamp the organ transplant system to improve access, equity, and transparency. There is a federal initiative to modernize the U.S. organ procurement system. The initiative includes the introduction of competitive bidding to administer the contract of the OPTN to provide de-monopolization of the infrastructure and bring more alternatives to improve the organization of the existing system.