Black Donors Research Articles

Variation of ApoL1 Testing Practices for Living Kidney Donors

Tests exist for ApoL1 genetic variants to determine whether a potential donor's kidneys are at increased risk of kidney failure. Variants of the ApoL1 gene associated with increased risk are primarily found in people with West African ancestry. Given uncertainty about clinical implications of ApoL1 test results for living kidney donors and recipients and the lack of uniform guidelines for ApoL1 testing, transplant centers across the United States vary in ApoL1 testing practices. (1) What approach do transplant centers take to determine whether prospective donors are of West African ancestry? (2)How do transplant centers engage potential donors during the ApoL1 testing process? (3) What do transplant centers identify as concerns and barriers to ApoL1 testing? and (4) What actions do transplant centers take when a potential donor has 2 ApoL1 risk variants? We explored the current practices of transplant centers by surveying nephrologists and transplant surgeons at transplant centers evaluating the majority of black living donors in the United States. About half of these transplant centers offered ApoL1 testing. Of those who offered ApoL1 testing, only half involved the donor in decision-making about donation when the donor has 2 risk variants. Unaddressed differences in the priorities of transplant centers and black living donors may stigmatize black donors and undermine trust in the health-care and organ donation systems. Variation in transplant center testing practices points to the critical need for further research and community engagement to inform the development of guidelines for ApoL1 testing.

152 An effective method of inducing oestrus in superovulation-treated Japanese Black donor cows after egg collection

The objective of this study was to evaluate the effect of inducing oestrus in superovulation-treated Japanese Black donor cows after egg collection using a controlled internal drug release (CIDR) device and prostaglandin F2α treatments. The test animals were 50 biparous or triparous Japanese Black cows that had been treated for superovulation during the period of 75-110 days post-calving and from each of which 10 or more ova or embryos had been recovered using a uterine reflux method. In the 25 cows of the control group that received the conventional treatment, a CIDR was not introduced into the vagina, the number of days from egg harvesting to standing oestrus was recorded, and AI was performed using frozen semen. At the time of AI, 50µg of gonadotrophin-releasing hormone (GnRH; Consultan, Aska Animal Health) was administered intramuscularly. The cows that did not conceive in the first AI attempt were again given the same AI and GnRH treatments in the next oestrus cycle. In the 25 cows of the treatment group, a CIDR (CIDR 1900, Zoetis) device was inserted in the vagina after egg harvesting and was kept there for 12 days. At the time of insertion and removal of the CIDR, 150µg of d-cloprostenol formulation (Dalmazin, Kyoritsu Seiyaku) was administered intramuscularly. The number of days from egg harvest to standing oestrus was recorded, and GnRH was administered at the time of AI. The cows that did not conceive in the first AI attempt were given the same AI and GnRH treatments in the next oestrus cycle. The control and treatment groups were compared for the number of days from egg harvesting to oestrus (t-test) and the conception rate after AI (chi-square test). The mean number of days from egg collection to standing oestrus in the control group was 38.6±11.9, and the conception rate was 60% (15/25). Among the animals that failed to conceive in the first AI attempt, the second standing oestrus occurred 60.7±13.1 days after egg collection, and 70% (7/10) of the cows conceived after the second AI. In the treatment group, on the other hand, the mean number of days from egg collection to standing oestrus was 15.8±3.9, and 72% (18/25) of the cows conceived after the first AI. Among the cows that failed to conceive, the second standing oestrus occurred 37.4±4.7 days after egg harvest, and 71% (5/7) of the cow conceived after the second AI. There was a significant difference between the two groups in the number of days from egg collection to the first standing oestrus (P<0.05). The results described above suggest that keeping a CIDR in the vagina for 12 days and intramuscularly administering prostaglandin F2α at the time of insertion and removal of the CIDR in superovulated cows are effective for early onset of standing oestrus after egg collection and thus can reduce the number of days to conception.

Donor-Recipient Relationship and Risk of ESKD in Live Kidney Donors of Varied Racial Groups

Risk factors for kidney failure are the basis of live kidney donor candidate evaluation. We quantified risk for end-stage kidney disease (ESKD) by the biological relationship of the donor to the recipient, a risk factor that is not addressed by current clinical practice guidelines. Retrospective cohort study. A cohort of 143,750 US kidney donors between 1987 and2017. Biological relationship of donor and recipient. ESKD. Donors' records were linked to national dialysis and transplantation registries to ascertain development of the outcome. Donors were observed over a median of 12 (interquartile range, 6-18; maximum, 30) years. Survival analysis methods that account for the competing risk for death were used. Risk for ESKD varied by orders of magnitude across donor-recipient relationship categories. For Asian donors, risks compared with unrelated donors were 259.4-fold greater for identical twins (95% CI, 19.5-3445.6), 4.7-fold greater for full siblings (95% CI, 0.5-41.0), 3.5-fold greater for offspring (95% CI, 0.6-39.5), 1.0 for parents, and 1.0 for half-sibling or other biological relatives. For black donors, risks were 22.5-fold greater for identical twin donors (95% CI, 4.7-107.0), 4.1-fold for full siblings (95% CI, 2.1-7.8), 2.7-fold for offspring (95% CI, 1.4-5.4), 3.1-fold for parents (95% CI, 1.4-6.8), and 1.3-fold for half-sibling or other biological relatives (95% CI, 0.5-3.3). For white donors, risks were 3.5-fold greater for identical twin donors (95% CI, 0.5-25.3), 2.0-fold for full siblings (95% CI, 1.4-2.8), 1.4-fold for offspring (95% CI, 0.9-2.3), 2.9-fold for parents (95% CI, 2.0-4.1), and 0.8-fold for half-sibling or other biological relatives (95% CI, 0.3-1.6). Insufficient sample size in some race and relationship groups. Absence of data for family history of kidney disease for donors biologically unrelated to their recipients. Marked differences in risk for ESKD across types of donor-recipient relationship were observed for Asian, black, and white donors. These findings warrant further validation with more robust data to better inform clinical practice guidelines.

Who do we gain? Enhancement of blood supplies by additional testing for donors who travel.

To describe the impact of additional testing on the England blood supply. The blood service for England, NHS Blood and Transplant, applies a system of deferral and testing to donors with potential exposure to Chagas disease, malaria and West Nile virus; however, testing costs must be justified. Here, we describe the donations and donors gained by testing. Donation testing results and demographic data on donors in England where additional testing was applied were analysed in 2012-2016. The total number and proportion of donations tested, reactive and confirmed positive were calculated. Proportions of donors requiring additional tests were calculated by ethnic group for first-time and repeat donors. Additional testing for travel was applied to 3·5% of NHSBT blood donations between 2012 and 2016. Over 98% of these tests were non-reactive. Only malaria tests were confirmed positive, in 1·7% of donations tested. In first-time donors, 45 and 40% of Asian and Black donors required an additional test, respectively, mainly for malaria. Testing for West Nile virus increased from 1·5% in 2012 to 2·2% of donations in 2016. The majority of additional tests were screened negative, allowing approximately 64 000 donations to be released for issue annually. Donors most affected by malaria testing were more likely to have rare blood groups and be targeted for recruitment, whereas those given West Nile virus testing were mainly regular donors required for continuity of supply. These data show differences in the characteristics of donors by test and can be used to inform decisions about additional testing and deferrals.

OR-MRS Cannot be used for Morbidity in Laparoscopic Sleeve Gastrectomy

Blacks have a greater need for kidney transplants than other American ethnic groups. Overrepresented on kidney transplant waiting lists (13%), they account for 35% of those waiting. Recent studies show that Black live donors are at greater risk for kidney failure, (44%) after donation, compared to other ethnicities. Explanations for these live donation data are few. While diabetic, hypertensive or morbidly obese Blacks are excluded as live donors; those overweight or obese are not.

Terahertz spectroscopy of human skin tissue models with different melanin content.

Terahertz imaging has been proposed for burns and skin cancer identification. However, the role of melanocytes, melanosomes, melanin content and distribution in determining the terahertz optical properties of human skin has not been investigated. We use terahertz time domain spectroscopy to measure the optical properties of in vitro pigmented human skin tissue models from Asian, Black, and Caucasian donors. Spectra were collected at various time intervals and used to extract the absorption coefficient and index of refraction at terahertz frequencies. Our results indicate that the degree of cell differentiation and type of donor both contribute to the measured terahertz optical properties.

High culture, black culture: Strategic assimilation and cultural steering in museum philanthropy

This article provides a case study of race and big-gift cultural patronage, a theoretically and empirically understudied phenomenon, by investigating million-dollar donations to the Smithsonian Institution by black patrons. I find that large donations by black supporters are concentrated at one Smithsonian museum – the National Museum of African American History and Culture. To explain this distinctive pattern of cultural consumption, I draw on ethnographic data and archival texts related to patronage at African American museums. Gifts to the National Museum of African American History and Culture can be partly explained by strategic acculturation, or an impulse to articulate and nurture black identity through consuming black culture. However, cultural steering also played a key role. Black donors were identified and cultivated via a robust fundraising infrastructure where market research cast them as key constituents of the National Museum of African American History and Culture and taste-making strategies that constructed the museum as worthy reinforced their attraction to the museum. By conceptually and empirically elaborating cultural steering, this analysis offers a more complete model of black middle- and upper-class consumption of black culture.

The changing landscape of live kidney donation in the United States from 2005 to 2017.

The number of live kidney donors has declined since 2005. This decline parallels the evolving knowledge of risk for biologically related, black, and younger donors. To responsibly promote donation, we sought to identify declining low-risk donor subgroups that might serve as targets for future interventions. We analyzed a national registry of 77427 donors and quantified the change in number of donors per 5-year increment from 2005 to 2017 using Poisson regression stratified by donor-recipient relationship and race/ethnicity. Among related donors aged <35, 35 to 49, and ≥50years, white donors declined by 21%, 29%, and 3%; black donors declined by 30%, 31%, and 12%; Hispanic donors aged <35 and 35 to 49 years declined by 18% and 15%, and those aged ≥50 increased by 10%. Conversely, among unrelated donors aged <35, 35 to 49, and ≥50 years, white donors increased by 12%, 4%, and 24%; black donors aged <35 and 35 to 49 years did not change but those aged ≥50 years increased by 34%; Hispanic donors increased by 16%, 21%, and 46%. Unlike unrelated donors, related donors were less likely to donate in recent years across race/ethnicity. Although this decline might be understandable for related younger donors, it is less understandable for lower-risk related older donors (≥50years). Biologically related older individuals are potential targets for interventions to promote donation.

BMI, Waist Size, GFR: In African American Blacks

Blacks have a greater need for kidney transplants than other American ethnic groups. Overrepresented on kidney transplant waiting lists (13%), they account for 35% of those waiting. Recent studies show that Black live donors are at greater risk for kidney failure, (44%) after donation, compared to other ethnicities. Explanations for these live donation data are few. While diabetic, hypertensive or morbidly obese Blacks are excluded as live donors; those overweight or obese are not.

The prevalence of human T-lymphotropic virus type 1 & 2 (HTLV-1/2) in South African blood donors.

Donated blood is not currently screened for human T-cell lymphotropic virus (HTLV) in South Africa. Several small studies have detected HTLV-1 in South Africa, but prevalence by geographic region or population group is unavailable. We performed a large seroprevalence study of South African blood donors during 3months in 2013. All geographic regions except the Western Cape were included, and Black and Coloured (local term for mixed race) donors were oversampled. Identity-unlinked plasma samples were screened with the Abbott Prism HTLV-1/2 assay, and repeatedly reactive samples were tested by the Inno-LIA HTLV-1/2 Score confirmatory assay. Odds ratios were calculated with multivariable logistic regression. Of 46752 donors tested, 133 (0·28%) were initially reactive, 111 (0·24%) repeatedly reactive and 57 (0·12%) confirmed positive for HTLV-1; none were HTLV-2 positive. Prevalence was 0·062% weighted to annual blood donations but highly concentrated in the Black population group (OR=20·24 CI: 2·77-147·88); higher in females than males (OR=1·81 CI: 1·06-3·08); and in donors aged >50years compared to ages 16-19 (OR=6·4 CI: 2·95-13·86). After controlling for age, sex and population group, there was no difference in prevalence between new and repeat blood donors or among geographic regions within South Africa. We conclude that HTLV-1 infection is widespread among the Black population of South Africa and its epidemiology is similar to other endemic areas. Because South Africa is increasing its recruitment of Black blood donors, the implications for blood screening require further consideration.

Reassessing the risk of kidney organ donation: Researchers are taking a closer look at the long-term health risks that living kidney donors may face to refine the informed consent process and improve follow-up care.

Reassessing the risk of kidney organ donation: Researchers are taking a closer look at the long-term health risks that living kidney donors may face to refine the informed consent process and improve follow-up care.

Mobilized Peripheral Blood Stem Cells Collection, a Retrospective Review of the Impact of Race/Ethnicity Among Autologous and Allogeneic Donors: A Single Center Experience

The impact of race/ethnicity on hematopoietic stem/progenitor cell (HSPC) mobilization remains controversial. Past studies have concluded Black healthy donors as more robust mobilizers or comparable mobilizers with Whites in response to granulocyte colony-stimulating factor (G-CSF). Whether ethnicity plays any role in HSPC mobilization in autologous donors was not studied. We conducted a single center retrospective study to examine effects of race/ethnicity on CD34+ cell mobilization both in allogeneic and autologous donors. Autologous donors included patients diagnosed with multiple myeloma (MM) and non-MM (non-Hodgkin's lymphoma, amyloidosis, POEM). Here we studied the self-reported race/ethnicity information and donor characteristics (63 autologous & 23 allogeneic). The donors were grouped as Black, White, Hispanic/Latino, and Asia Pacific Islanders (API). Both autologous and allogeneic donors received G-CSF for 5 days and plerixafor was administered on day 4/5 to autologous donors. Our data show that Black autologous donors had significantly higher CD34+ cell yield per liter blood in comparison to Whites and Hispanics respectively {mean ± SD (39.8 ± 23.9 vs. 24.3 ± 20.6 vs 22.5 ±16.1) × 106 CD34+ cells/liter, p=0.0184, n=63). Interestingly, the same trend was observed when we compared allogeneic donors (Black 45.1 ± 34.1 vs. White 20.2 ± 7.5 vs. Hispanic 47.1 ± 15.3) CD34+ cells/liter × 106, p=0.3699, n=23). The CD34+ cell yield between females and males among autologous or allogeneic donors was not statistically significant. Using multivariate analysis to evaluate CD34+ cell yields among different race/ethnicity, controlling for other variables in the model, autologous MM donors had the highest CD34+ cells yield than other groups (β_non-MM = −0.77, p- = 0.0003). Although Black MM donors had higher CD34+ cell yields than Whites or Hispanics, the CD34+ cell yields between the MM donors and healthy donors was surprisingly comparable both among Blacks and Whites. MM donors had higher CD34+ cell yields than any other groups. The above results support the view that therapies used in MM patients are likely more conducive of recovery of HSPCs. The superior CD34+ cell yields from MM patients in spite of lenalidomide-based therapies with known myelosuppressive potential is intriguing. Taken together, our study shows that MM patients display higher mobilizing ability than non-MM. Interestingly, when MM donors are compared with allogeneic donors, both Blacks and Whites retain comparable CD34+ cell yields. The increase in CD34+ cell yields in Blacks was more profound among autologous MM donors. The underlying biologic basis of higher CD34+ cell yields in Black donors warrants future investigation. Ongoing evaluation of donor characteristics and response to mobilization regimens would support development of novel strategies tailored to individual race/ethnicity groups in the future.

Incidence of Recurrent NASH-Related Allograft Cirrhosis.

Cirrhosis secondary to nonalcoholic steatohepatitis (NASH) is projected to become the leading indication for liver transplantation (LT) in the USA in the next decade. The long-term implications of post-LT NASH, specifically on the development of allograft cirrhosis, are not well known. A retrospective cohort of patients at a single large center undergoing LT for NASH from 2000 to 2015 was identified using a prospectively collected database. A total of 226 patients undergoing LT for NASH were identified. Mean follow-up for the cohort was 7years. Seventy-five percent of patients underwent at least one liver biopsy post-LT. Eighty-one patients (36%) developed recurrence of biopsy-proven NASH. Fifteen patients developed bridging fibrosis but only four patients (1.8%) progressed to recurrent NASH cirrhosis at a mean of 9years post-LT. Body mass index at the time of LT was statistically higher in the NASH allograft cirrhosis group. Recurrent disease was less common and less severe in those transplanted with black donors. All four patients with recurrent NASH cirrhosis developed evidence of portal hypertension, but all remained alive at follow-up. Although recurrent NASH following LT is common, the development of allograft cirrhosis is rare. These findings are useful when counseling patients and important to consider during their post-LT care.

The iron status of South African blood donors: balancing donor safety and blood demand

Several studies in developed countries have demonstrated high levels of iron deficiency (ID) among blood donors. There is a paucity of data for developing countries where blood shortages remain a major concern. A total of 4412 donors were enrolled in the study. Specimens were collected for full blood count, iron, transferrin saturation, and ferritin assessment. Donor demographics were recorded. ID was indicated by a ferritin level of less than 20 ng/mL for men and less than 12 ng/mL for women. Anemia was defined as hemoglobin levels less than 12.5 g/dL. Regression models for predictors of ID were developed. A total of 17.5% of all donors had ID, with 16.3% prevalence in women and 18.6% in men. Low hemoglobin had the highest association with ID (adjusted odds ratio [AOR], 11.078; 95% confidence interval [CI], 7.915-15.505); male donors had twice the odds of ID compared to female donors (AOR, 2.501; 95% CI, 1.964-3.185), while increasing age was associated with lower odds (AOD, 0.965; 95% CI, 0.956-0.975). Among male donors, an interdonation interval of less than 3 months (AOR, 2.679; 95% CI, 1.929-3.720) was associated with ID. Compared to other females combined, colored female donors (AOR, 2.335; 95% CI, 1.310-4.160) had higher odds and black female donors (AOR, 0.559; 95% CI, 0.369-0.845) lower odds of ID. ID is common among South African donors; low hemoglobin, gender, ethnicity, and past donation history is independently associated with ID. Recommendations aimed at protecting donor health may increase blood shortages in South Africa.

Assessment of HIV transfusion transmission risk in South Africa: a 10-year analysis following implementation of individual donation nucleic acid amplification technology testing and donor demographics eligibility changes.

In 1998 we estimated that 34/million infectious window period donations were entering the blood supply at the South African National Blood Service. Selective use of donations based on donor race-ethnicity reduced this risk to 26/million donations but was deemed unethical. Consequently, in 2005 South African National Blood Service eliminated race-ethnicity-based collection policies and implemented individual-donation nucleic acid testing (ID-NAT). We describe the change in donor base demographics, human immunodeficiency virus (HIV) detection rates, and transfusion-transmissible HIV risk. In ten years 7.7 million donations were tested for anti-HIV and HIV RNA. Number of donations, HIV prevalence, ID-NAT yield rate, serology yield rate and residual transfusion-transmissible HIV risk were analyzed by donor type, race-ethnicity, age, and sex. Multiple regression analysis was performed to investigate the determinants of HIV-positive and nucleic acid testing yield donations. The combined strategy of increasing donations from black donors and implementing ID-NAT increased the proportion of donations from black donors from 6% in 2005 to 30% in 2015 (p < 0.00001), and reduced the transfusion-transmissible risk from 24 to 13 per million transfusions. ID-NAT interdicted 481 (1:16,100) seronegative window period donations, while one transfusion-transmissible case (0.13 per million) was documented. Race-ethnicity and donor type were highly significant predictors of HIV positivity, with adjusted odds ratio for first-time donors of 12.5 (95% confidence interval, 11.9-13.1) and for black race-ethnicity of 31.1 (95% confidence interval, 28.9-33.4). The proportion of serology yields among HIV-infected donors increased from 0.27% to 2.4%. ID-NAT enabled the South African National Blood Service to increase the number of donations from black donors fivefold while enhancing the safety of the blood supply.

Impact of changes to donor hemoglobin criteria on the rate of donor deferral.

The Food and Drug Administration's requirements for "Blood and Blood Components Intended for Transfusion or Further Manufacturing Use" (Final Rule) effective May 2016 changed eligibility criteria for blood donors. A multivariate analysis was performed to measure its impact on donor deferral rates. Four blood centers submitted data for similar 6-month periods before and after implementation of the Final Rule. Data included presenting donors, units collected, deferrals, intended products from deferred donors, deferral reasons, presenting donor demographics, donor hemoglobin (Hgb), hematocrit (HCT), pulse, blood pressure (BP), temperature, and other reasons for deferral. Data were aggregated and periods compared. After Final Rule implementation, successful donations decreased by 1.3% (83.1%-81.9%), despite a 0.2% increase in presenting donors. The rate of Hgb/HCT, pulse, and deferrals increased, while deferrals for other reasons decreased. Male Hgb/HCT deferral rates increased 1.2% (4213 total). Black male donors' Hgb/HCT deferral rate increased (2.7%-5.2%) but was counterbalanced by an overall 3.7% decrease in black female Hgb/HCT deferrals. While Hgb/HCT deferrals of black donors remained stable overall (17.0% vs. 16.2%), this trend was not observed by all centers. Deferrals for pulse increased (0.2%), as did BP deferrals (0.2%). Although there was a small increase in presenting donors after implementation of the Final Rule, there was a decrease in successful donations. While it appeared that deferral in black donors was unchanged, this trend was not observed across all centers. Pulse and BP deferrals rose dissimilarly among centers, according to individual procedures.

Suitability of Estimated Glomerular Filtration Rate for Live Kidney Donor Selection

IntroductionThe assessment of the glomerular filtration rate (GFR) in kidney donor candidates is required for determining donor candidate acceptability. This assessment can be done using an estimated GFR (eGFR) or a measured GFR (mGFR). The primary objective of the present study was to compare, in healthy adult kidney donor candidates, GFR measured by the clearance of iothalamate to GFR estimated using the Chronic Kidney Disease Epidemiology Collaboration equation and to determine if eGFR was a suitable stand-alone assessment. A secondary objective was to explore demographic factors that affect the relationship of the eGFR and the mGFR. MethodsA retrospective review of kidney donor candidates' records at the J. C. Walter, Jr., Transplant Center, Houston Methodist Hospital, from January 2013 to March 2016 was undertaken. GFR was measured by the plasma clearance of radioisotopic iothalamate and estimated using the Chronic Kidney Disease Epidemiology Collaboration equation. ResultsThe median mGFR was 108 mL/min/1.73 m2. The eGFR underestimated the mGFR by 11.5%. The underestimation was greatest in subjects with an mGFR of ≥90 mL/min/1.73 m2. The eGFR overestimated the mGFR in donor candidates of black race. ConclusionsThe Chronic Kidney Disease Epidemiology Collaboration eGFR can be used for screening potential kidney donors restricting the use of iothalamate (mGFR) to those donors with an eGFR below the transplant centers' acceptable GFR threshold for donation, thereby effecting cost savings and greater donor convenience. The eGFR in black donor candidates should be used with caution.

1290 Despite abnormal vitamin D receptor expression in keloid scars, keloid keratinocytes can respond to vitamin D treatment in vitro

Keloids are fibroproliferative scars that are more prevalent in populations with darkly pigmented skin, such as African Americans. The basis for increased keloid susceptibility in skin of color is not known. Vitamin D is produced in skin in response to UV light, and rates of vitamin D deficiency are higher in populations with darker skin. Vitamin D, through binding of the vitamin D receptor (VDR), regulates calcium homeostasis, cell proliferation, differentiation, inflammation, and fibrosis. Hypothetically, the link between pigmentation and keloid formation may involve vitamin D signaling. Because ligand-bound VDR acts as a transcription factor, ligand-dependent target gene regulation requires nuclear localization. VDR expression and nuclear localization were analyzed in keloid scars (N=24) and normal skin (N=24). Immunohistochemistry demonstrated reduced VDR levels in most keloids, and the percentage of epidermal nuclei positive for VDR was significantly lower in keloids vs. normal skin. Keloid scars of black (N=18) or white (N=6) donors showed significantly reduced VDR nuclear localization vs. normal epidermis of black (N=12) or white (N=12) donors, respectively. Further, among normal samples, VDR nuclear localization was significantly lower in epidermis of black vs. white donors. To determine if keloid cells are competent to respond to vitamin D stimulation, keratinocytes were isolated from keloid scars and normal skin samples (N=4 each). VDR mRNA expression levels were similar in keloid and normal keratinocytes in vitro, and treatment with 100 nM calcitriol significantly increased expression of the vitamin D target genes Cathelicidin and CYP24A1 in both groups. The results suggest that VDR is involved in keloid pathology and hint at a possible role for VDR in the increased susceptibility to keloid scarring in individuals with darkly pigmented skin. Further, because keloid keratinocytes can respond to vitamin D treatment by appropriate upregulation of target genes, the results suggest a potential therapeutic role for vitamin D in prevention or treatment of keloids.

An Examination of the Application of the Kidney Donor Risk Index in British Columbia.

Background:The Kidney Donor Risk Index (KDRI) is a continuous measure of deceased donor kidney transplant failure risk that was derived in US patients based on 10 donor characteristics. In the United States, the KDRI is utilized to guide organ allocation and to inform clinical decisions regarding organ acceptance.Objective:To examine the application of the US-derived KDRI in a large Canadian province.Patients:All deceased donor kidney-only transplant recipients in British Columbia (BC) between 2005 and 2014.Methods:We examined the predictive performance of KDRI in BC transplant recipients and compared the overall performance of KDRI with donor age alone in predicting transplant failure (from all causes including death).Results:Donors in BC (N = 785) were older but included no black donors and few Hepatitis C virus (HCV)-positive donors compared with the original derivation cohort of the KDRI in the United States. The KDRI was moderately predictive of transplant failure (c statistic, 0.63) and had similar predictive performance to donor age alone (c statistic, 0.64).Conclusion:Our findings suggest that the US-derived KDRI does not improve the prediction of kidney transplant failure compared with donor age alone in a Canadian cohort and highlight the need to determine the applicability of KDRI in different regions.

Donor and Recipient Ethnicity Impacts Renal Graft Adverse Outcomes.

Renal transplant outcomes have been shown to be impacted by ethnicity. Prior studies have evaluated the disparate transplant outcomes of Black recipients and recipients of Black donors. However, it has remained unclear whether other donor ethnicities independent of medical comorbidities can influence transplant outcomes. Utilizing the Scientific Registry of Transplant Recipients (SRTR) (with greater than 100,000 patients), we evaluated the effect of each ethnicity, Black, American Indian, Hispanic, Native Hawaiian or other Pacific Islander, and Asian as compared to White recipients on adverse kidney transplant outcomes, assessing for delayed graft function, positive urine protein, acute rejection, and graft failure. Additionally, we assessed the interplay of donor ethnicity on recipient transplant outcomes, which has not previously been comprehensively examined. Logistic regression analysis that took into consideration gender, age, comorbidities, graft type, donor ethnicity, body mass index (BMI), HLA mismatch, ever been on hemodialysis, and time on dialysis indicates that Black recipients have worse outcomes compared to Whites in all outcomes assessed. A logistic regression analysis showed that recipient ethnicity was an independent risk factor for adverse outcomes. Notably, we found that donor ethnicity also independently affects graft outcomes. Hispanic donors lead to better outcomes in Whites and Blacks, while Asian donors have the best outcomes amongst Asian recipients. Recipients of Black donors fared the worst of all ethnicity donors. These data suggest the potential importance of risk stratification for the donor allograft and developing risk calculators that include both donor and recipient ethnicity may be useful, which the current Kidney Donor Profile Index (KDPI) does not currently take into account as they give black donors a different weight, but the same score is assigned to Whites, Asians, and Hispanics.