NephMadness Choosing Wisely Campaign: Kidney Donor Risk vs Virally Infected Kidneys (#TransplantRegion)

Blog Post

The first matchup in the #TransplantRegion leaves us with two tantalizing options: “Kidney Donor Risk” and “Virally Infected Kidneys”. How does one possibly choose between the bold risk one takes when choosing to save a life and the now possible but previously unimaginable transplantation of kidneys infected with Human Immunodeficiency Virus (HIV) the curable Hepatitis C (HCV)?

Let’s take a quick look at team #KidneyDonorRisk. Why should we care about kidney donor risk? Well, even the first kidney donor in 1954 ultimately progressed to end stage renal disease (ESRD)…

Since 1954, we have developed new tools to better quantify a potential kidney donor’s ESKD  risk, like this calculator – which can be used to calculate any donor’s pre-donation 15 year and life time ESKD risk. In addition, 2-time APOL1 champion may easily carry this team to the saturated 16. Would you advise kidney donation to a patient with 2 APOL1 risk alleles, given that 2 out of 19 patients developed ESKD after a median follow up of one year in one small study? If you’re still not convinced, take another look at @KristaLentine’s support of this team as the winner of not only this matchup, but also of the entire #TransplantRegion. She emphasizes the importance of the understanding of donor risk and transparency of communicating this risk.

If #KidneyDonorRisk isn’t your thing, maybe you’re a believer in the #VirallyInfectedKidneys.

And why wouldn’t you be? The THINKER trial showed us that HCV + kidneys can now be transplanted into HCV – recipients, with successful treatment of HCV post transplantation. A limited kidney donor pool may ultimately be significantly expanded, if HCV+ kidneys are no longer discarded.  Similarly, the HOPE (HIV Organ Policy Equity) Act has resulted in the transplantation of HIV+ organs and promising  overall and graft survival rates.

Now what? You’ve read @paulphel‘s comprehensive scouting report and seen enough visual abstracts, but all that really matters is the Blue Ribbon Panel. I predict team #KidneyDonorRisk to win this matchup, and here are the 5 of 9 Blue Ribbon Panelists that I’m most confident will help advance it to the next round:

  1. @FionaCLoud:  She’s a kidney transplant recipient and fierce advocate. It seems likely that she’ll keep #KidneyDonorRisk in her bracket.
  2. @DrDeidraCrews:  She researches the impact of racial disparities on chronic kidney disease, and has published on the disparities in access to kidney transplantation.
  3. @Mike_J_Choi: He’s an author on a 2013 NEJM study describing APOL1 risk variants, race, and progression of CKD. I don’t expect him to forget about APOL1 so quickly.
  4. Tazeen Jafar – She has studied predictors of low eGFR after kidney donation, in a Southeast population from Singapore.
  5. @medicalaxioms –  He probably cares about the #KidneyDonorRisk. The tweet below says it all:

Ready to make your pick? Submit your bracket here.

Samira Farouk, NSMC Intern 2018 @ssfarouk