The Faltering Solid Organ Donor Pool in the United States (2001–2010)

Background: The opioid crisis has led to a dramatic increase in the number of drug overdose deaths in the United States. Little is known about the effect of the opioid crisis on the kidney transplant donor pool, particularly on hepatitis C virus (HCV)-infected donors. Methods: This is a retrospective analysis of the data from the Organ Procurement and Transplantation Network from 2010 to 2016. We determined the changes in characteristics of kidney transplant donors and evaluated which changes may be directly related to the opioid crisis. Results: Between 2010 and 2016, we found a 26% increase in overall donors, including a 277% increase in the number of donors who died from drug overdose. Nineteen percent of donors who died of drug overdose had HCV infection. Donors who die from drug overdose and donors with HCV infection are younger, less likely to have diabetes or hypertension, and have favorable kidney donor profile index scores compared to average donors. Despite these favorable characteristics, HCV-infected donors appear to be notably underutilized, with substantially lower kidneys per donor being transplanted compared to HCV uninfected donors. Conclusion: The opioid crisis in the United States has substantially altered the kidney donor pool. Strategies to increase utilization of all potentially viable kidneys for transplant are needed, particularly in this era of new, highly effective, direct-acting antiviral therapy for HCV infection.

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Herpes Zoster Risk in Immunocompromised Adults in the United States: A Systematic Review

Clinical Infectious Diseases ◽

10.1093/cid/ciz1090 ◽

2019 ◽

Vol 71 (7) ◽

pp. e125-e134 ◽

Cited By ~ 5

Author(s):

Susannah L McKay ◽

Angela Guo ◽

Steven A Pergam ◽

Kathleen Dooling

Keyword(s):

United States ◽

Herpes Zoster ◽

Organ Transplant ◽

Original Data ◽

Hematologic Malignancies ◽

The United States ◽

People Living With Hiv ◽

Solid Organ ◽

Assessment Development ◽

Cell Transplants

Abstract Background The primary reported risk factors for herpes zoster (HZ) include increasing age and immunodeficiency, yet estimates of HZ risk by immunocompromising condition have not been well characterized. We undertook a systematic literature review to estimate the HZ risk in immunocompromised patients. Methods We systematically reviewed studies that examined the risk of HZ and associated complications in adult patients with hematopoietic cell transplants (HCT), cancer, human immunodeficiency virus (HIV), and solid organ transplant (SOT). We identified studies in PubMed, Embase, Medline, Cochrane, Scopus, and clinicaltrials.gov that presented original data from the United States and were published after 1992. We assessed the risk of bias with Cochrane or Grading of Recommendations Assessment, Development, and Evaluation methods. Results We identified and screened 3765 records and synthesized 34 studies with low or moderate risks of bias. Most studies that were included (32/34) reported at least 1 estimate of the HZ cumulative incidence (range, 0–41%). There were 12 studies that reported HZ incidences that varied widely within and between immunocompromised populations. Incidence estimates ranged from 9 to 92 HZ cases/1000 patient-years and were highest in HCT, followed by hematologic malignancies, SOT, and solid tumor malignancies, and were lowest in people living with HIV. Among 17 HCT studies, the absence of or use of antiviral prophylaxis at <1 year post-transplant was associated with a higher HZ incidence. Conclusions HZ was common among all immunocompromised populations studied, exceeding the expected HZ incidence among immunocompetent adults aged ≥60 years. Better evidence of the incidence of HZ complications and their severity in immunocompromised populations is needed to inform economic and HZ vaccine policies.

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Trauma Patients’ Attitudes toward Organ Donation at an Urban Level I Trauma Center

The American Surgeon ◽

10.1177/000313481808400957 ◽

2018 ◽

Vol 84 (9) ◽

pp. 1493-1497

Author(s):

John D. Cull ◽

Katarina Ivkovic ◽

Benjamin Manning ◽

Edie Y. Chan

Keyword(s):

United States ◽

Organ Donation ◽

Trauma Center ◽

Family Members ◽

Organ Donor ◽

The United States ◽

Trauma Patients ◽

Willingness To Donate ◽

Patient Responses ◽

Level I

Many health-care workers (HCWs) surveyed at a trauma center believed their patients distrusted the organ allocation system. This study compares urban trauma patients’ (TPs) attitudes toward organ donation with attitudes from the 2012 National Survey of Organ Donation Attitudes (NSODA). TPs presenting to the trauma clinic between September 2014 and August 2015 were surveyed. Patient responses were compared with the 2012 NSODA. One hundred and thirty-three TPs (95.0%) responded to the survey. Compared with the 2012 NSODA, groups were similar with regard to a patient's desire for OD after death (Trauma: 62.4% [Confidence interval [CI]: 53.6–70.7] vs NSODA: 59.3% [CI: 56.6–61.8]) and the belief that doctors are less likely to save their life if they are an organ donor (24.8% [CI: 17.7–33.0] vs 19.6% [CI: 18.3–21.0]). Approximately, 30 per cent of patients believed discrimination prevented minority patients from receiving transplants (27.1 [CI: 19.7–35.5] vs 30.3 [CI: 28.8–31.9]). TPs were less likely than the NSODA group to donate a family members’ organs, if they did not know the family members’ wishes (56.4% [CI: 47.5–65.0] vs 75.6% [CI: 68.7–71.8]); TPs were less likely to believe the United States transplant system uses a fair approach to distribute organs (47.4% [38.7–56.2] vs 64.6% [CI: 63.0–66.2]). Adjusting for race, both groups were similar in their willingness to donate a family members’ organs; black TPs were less likely to believe the United States transplant system, which follows a fair approach in distributing organs (43.0% [CI: 32.4–54.2] vs 63.7% [59.7–67.6]). Despite HCWs perceptions, TPs had a positive view of OD. Educating HCWs on patient attitudes toward OD may decrease institutional barriers to OD.

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Abstract 1056: Elevated incidence of rare cancers among solid organ transplant recipients (SOTRs) in the United States

10.1158/1538-7445.am2020-1056 ◽

2020 ◽

Author(s):

Eric Engels ◽

Monica D'Arcy ◽

Ruth Pfeiffer ◽

Meredith Shiels ◽

Lindsay Morton ◽

...

Keyword(s):

United States ◽

Organ Transplant ◽

The United States ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Organ Transplant Recipients ◽

Rare Cancers ◽

Solid Organ Transplant Recipients

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Sebaceous Carcinoma Incidence and Survival Among Solid Organ Transplant Recipients in the United States, 1987-2017

JAMA Dermatology ◽

10.1001/jamadermatol.2020.3111 ◽

2020 ◽

Vol 156 (12) ◽

pp. 1307

Author(s):

Michael R. Sargen ◽

Elizabeth K. Cahoon ◽

Charles F. Lynch ◽

Margaret A. Tucker ◽

Alisa M. Goldstein ◽

...

Keyword(s):

United States ◽

Organ Transplant ◽

The United States ◽

Solid Organ Transplant ◽

Sebaceous Carcinoma ◽

Solid Organ ◽

Transplant Recipients ◽

Organ Transplant Recipients ◽

Solid Organ Transplant Recipients

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Clinical outcomes and serologic response in solid organ transplant recipients with COVID‐19: A case series from the United States

American Journal of Transplantation ◽

10.1111/ajt.16079 ◽

2020 ◽

Vol 20 (11) ◽

pp. 3225-3233 ◽

Cited By ~ 14

Author(s):

Monica Fung ◽

Charles Y. Chiu ◽

Catherine DeVoe ◽

Sarah B. Doernberg ◽

Brian S. Schwartz ◽

...

Keyword(s):

United States ◽

Clinical Outcomes ◽

Organ Transplant ◽

Case Series ◽

The United States ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Serologic Response ◽

Solid Organ Transplant Recipients

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1629. Herpes Zoster Risk in Immunocompromised Adults in the United States: A Systematic Review

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1493 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S594-S595

Author(s):

Kathleen L Dooling ◽

Angela Guo ◽

Steven A Pergam ◽

Susannah McKay

Keyword(s):

United States ◽

Systematic Review ◽

Herpes Zoster ◽

Solid Tumor ◽

Cumulative Incidence ◽

Medical Condition ◽

The United States ◽

Risk Of Bias ◽

Solid Organ ◽

Antiviral Prophylaxis

Abstract Background The two known primary risk factors for herpes zoster (HZ) are age and immunodeficiency yet estimates of HZ risk by immunocompromising medical condition have not been well characterized. We undertook a systematic review of the literature to estimate HZ risk in six categories of immunocompromised patients. Methods We conducted a systematic review of evidence for HZ in patients with hematopoietic cell transplants (HCT), cancer (blood and solid tumor), HIV, and solid-organ transplant (SOT; kidney and other). We identified studies in Pubmed, Embase, Cochrane, Scopus and clinicaltrials.gov using the following outcome search terms: Herpes Zoster, Shingles, VZV, chickenpox, Varicella-zoster virus, or opportunistic infection. We included articles that presented original data from studies in the United States on risk of HZ in adults and were published after 1992 (1996 for HIV). Case reports and conference abstracts were excluded. We assessed risk of bias with Cochrane (clinical trials) or GRADE (observational) methods and categorized studies as high, medium, or low risk. Results We identified and screened 3,765 records; 57 articles were abstracted and 34 deemed low or moderate risk of bias (Figure 1). All articles reported at least one estimate of HZ cumulative incidence, which ranged from 0% to 41%. Thirteen studies estimated HZ incidence, which varied widely within and between immunocompromised populations (Figure 2). The highest estimates were seen in HCT (median = 52 HZ cases/1000 patient-years), followed by blood cancers and SOT, and then solid tumor cancers and HIV (median = 13 HZ cases/1,000 patient-years). Among 17 studies of HCT patients, longer follow-up time and absent or <1 year of post-transplant antiviral prophylaxis were associated with higher HZ cumulative incidence (Figure 3). Conclusion HZ is common among all immunocompromised populations studied—exceeding expected HZ incidence in immunocompetent middle-age adults. Antiviral prophylaxis among HCT patients has an ameliorating effect but long-term HZ risk following discontinuation is unclear. Better evidence for incidence and severity of HZ in immunocompromised populations is needed to inform economic and HZ vaccine policy analyses. Disclosures All authors: No reported disclosures.

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