Dataset Information

The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States: A National Registry Study.

ABSTRACT: Background:The epidemic of drug overdose deaths in the United States has led to an increase in organ donors. Objective:To characterize donors who died of overdose and to analyze outcomes among transplant recipients. Design:Prospective observational cohort study. Setting:Scientific Registry of Transplant Recipients, 1 January 2000 to 1 September 2017. Participants:138 565 deceased donors; 337 934 transplant recipients at 297 transplant centers. Measurements:The primary exposure was donor mechanism of death (overdose-death donor [ODD], trauma-death donor [TDD], or medical-death donor [MDD]). Patient and graft survival and organ discard (organ recovered but not transplanted) were compared using propensity score-weighted standardized risk differences (sRDs). Results:A total of 7313 ODDs and 19 897 ODD transplants (10 347 kidneys, 5707 livers, 2471 hearts, and 1372 lungs) were identified. Overdose-death donors accounted for 1.1% of donors in 2000 and 13.4% in 2017. They were more likely to be white (85.1%), aged 21 to 40 years (66.3%), infected with hepatitis C virus (HCV) (18.3%), and increased-infectious risk donors (IRDs) (56.4%). Standardized 5-year patient survival was similar for ODD organ recipients compared with TDD organ recipients (sRDs ranged from 3.1% lower to 3.9% higher survival) and MDD organ recipients (sRDs ranged from 2.1% to 5.2% higher survival). Standardized 5-year graft survival was similar between ODD and TDD grafts (minimal difference for kidneys and lungs, marginally lower [sRD, -3.2%] for livers, and marginally higher [sRD, 1.9%] for hearts). Kidney discard was higher for ODDs than TDDs (sRD, 5.2%) or MDDs (sRD, 1.5%); standardization for HCV and IRD status attenuated this difference. Limitation:Inability to distinguish between opioid and nonopioid overdoses. Conclusion:In the United States, transplantation with ODD organs has increased dramatically, with noninferior outcomes in transplant recipients. Concerns about IRD behaviors and hepatitis C among donors lead to excess discard that should be minimized given the current organ shortage. Primary Funding Source:National Institutes of Health.

SUBMITTER: Durand CM

PROVIDER: S-EPMC6205229 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States: A National Registry Study.

Durand Christine M CM Bowring Mary G MG Thomas Alvin G AG Kucirka Lauren M LM Massie Allan B AB Cameron Andrew A Desai Niraj M NM Sulkowski Mark M Segev Dorry L DL

Annals of internal medicine 20180417 10

<h4>Background</h4>The epidemic of drug overdose deaths in the United States has led to an increase in organ donors.<h4>Objective</h4>To characterize donors who died of overdose and to analyze outcomes among transplant recipients.<h4>Design</h4>Prospective observational cohort study.<h4>Setting</h4>Scientific Registry of Transplant Recipients, 1 January 2000 to 1 September 2017.<h4>Participants</h4>138 565 deceased donors; 337 934 transplant recipients at 297 transplant centers.<h4>Measurements< ...[more]

PMID: 29710288

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Project description:Induction therapy in deceased donor kidney transplantation is costly, with wide discrepancy in utilization and a limited evidence base, particularly regarding cost-effectiveness.We linked the United States Renal Data System data set to Medicare claims to estimate cumulative costs, graft survival, and incremental cost-effectiveness ratio (ICER - cost per additional year of graft survival) within 3 years of transplantation in 19 450 deceased donor kidney transplantation recipients with Medicare as primary payer from 2000 to 2008. We divided the study cohort into high-risk (age > 60 years, panel-reactive antibody > 20%, African American race, Kidney Donor Profile Index > 50%, cold ischemia time > 24 hours) and low-risk (not having any risk factors, comprising approximately 15% of the cohort). After the elimination of dominated options, we estimated expected ICER among induction categories: no-induction, alemtuzumab, rabbit antithymocyte globulin (r-ATG), and interleukin-2 receptor-antagonist.No-induction was the least effective and most costly option in both risk groups. Depletional antibodies (r-ATG and alemtuzumab) were more cost-effective across all willingness-to-pay thresholds in the low-risk group. For the high-risk group and its subcategories, the ICER was very sensitive to the graft survival; overall both depletional antibodies were more cost-effective, mainly for higher willingness to pay threshold (US $100 000 and US $150 000). Rabbit ATG appears to achieve excellent cost-effectiveness acceptability curves (80% of the recipients) in both risk groups at US $50 000 threshold (except age > 60 years). In addition, only r-ATG was associated with graft survival benefit over no-induction category (hazard ratio, 0.91; 95% confidence interval, 0.84-0.99) in a multivariable Cox regression analysis.Antibody-based induction appears to offer substantial advantages in both cost and outcome compared with no-induction. Overall, depletional induction (preferably r-ATG) appears to offer the greatest benefits.

Dataset Information

The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States: A National Registry Study.

Publications

The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States: A National Registry Study.

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