Methamphetamine use in deceased kidney donors impairs one‐yr graft function*

Inouye, David; Kickertz, Katherine

doi:10.1111/j.1399-0012.2007.00703.x

Cited by 6 publications

(6 citation statements)

References 24 publications

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“…Organ procurement organizations play a major role in organ procurement and allocation, and as such also meaningfully contribute to these regional differences (34). Volatile numbers of available deceased donors can greatly influence availability of organs in a given year for each organ procurement organization (35). If a center simply does not have enough access to kidneys within their donation service area or region, they often resort to importing from other regions to fill their need.…”

Section: Discussionmentioning

confidence: 99%

A Donor Utilization Index to Assess the Utilization and Discard of Deceased Donor Kidneys Perceived as High Risk

Brennan¹,

Husain²,

King³

et al. 2019

CJASN

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Background and objectives An increasing number of patients on the waitlist for a kidney transplant indicates a need to effectively utilize as many deceased donor kidneys as possible while ensuring acceptable outcomes. Assessing regional and center-level organ utilization with regards to discard can reveal regional variation in suboptimal deceased donor kidney acceptance patterns stemming from perceptions of risk.Design, setting, participants, & measurements We created a weighted donor utilization index from a logistic regression model using high-risk donor characteristics and discard rates from 113,640 deceased donor kidneys procured for transplant from 2010 to 2016, and used it to examine deceased donor kidney utilization in 182 adult transplant centers with .15 annual deceased donor kidney transplants. Linear regression and correlation were used to analyze differences in donor utilization indexes. ResultsThe donor utilization index was found to significantly vary by Organ Procurement and Transplantation Network region (P,0.001), revealing geographic trends in kidney utilization. When investigating reasons for this disparity, there was no significant correlation between center volume and donor utilization index, but the percentage of deceased donor kidneys imported from other regions was significantly associated with donor utilization for all centers (rho=0.39; P,0.001). This correlation was found to be particularly strong for region 4 (rho=0.83; P=0.001) and region 9 (rho=0.82; P=0.001). Additionally, 25th percentile time to transplant was weakly associated with the donor utilization index (R 2 =0.15; P=0.03).Conclusions There is marked center-level variation in the use of deceased donor kidneys with less desirable characteristics both within and between regions. Broader utilization was significantly associated with shorter time to transplantation.

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Section: Discussionmentioning

confidence: 99%

A Donor Utilization Index to Assess the Utilization and Discard of Deceased Donor Kidneys Perceived as High Risk

Brennan¹,

Husain²,

King³

et al. 2019

CJASN

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“…[9] A review of the histopathological findings in drug users does not mention any renal effects in amphetamine users. [10] There have been isolated reports of adverse renal effects including necrotising renal vasculopathy, [8] an exaggerated decline in renal function over 15-year follow-up of patients who used methamphetamines, [11] an increased serum creatinine level 1 year after transplant in recipients of kidneys from donors who had used methamphetamines, [12] and early graft loss of two kidneys from donors who had used methamphetamines. [13] In Africa there is even less information on the health outcomes of methamphetamine use.…”

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confidence: 99%

Hypertension, end-stage renal disease and mesangiocapillary glomerulonephritis in methamphetamine users

Jones

Rayner

2015

S Afr Med J

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Background. Methamphetamine abuse has risen dramatically in South Africa. The chronic effects of abuse on the kidneys and blood pressure have not been documented. This study reviewed patients referred for evaluation of kidney disease and/or hypertension, who had been abusing methamphetamines. Methods. The records of patients referred to the renal unit between 2005 and 2013 who had been using methamphetamines were retrospectively reviewed. Patient demographics, biophysical parameters, blood pressure, renal function, renal ultrasound and biopsy findings, complications of chronic kidney disease and comorbidities were recorded. Results. Forty-seven patients were included in the study. Their mean age was 29 years. Hypertension was present in 42 (89.4%) of patients, with malignant hypertension in 21 (44.7%). Forty-five (95.7%) had chronic kidney disease (CKD), and 26 (55.3%) had end-stage renal disease. Renal biopsies were performed in 24 patients. Twelve (50.0%) of the biopsies showed hypertensive changes and 14 (58.3%) mesangiocapillary glomerulonephritis type 1, with deposition of IgM and C3 complement. Conclusion. Methamphetamine use is associated with severe hypertension, mesangiocapillary glomerulonephritis and CKD.

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“…22,23 Previous studies from this group have demonstrated impaired creatinine in recipients who received kidneys from donors who used methamphetamine, but this was more evident in serum creatinine at 1 year. 24 Although homelessness was not observed to affect short-term graft survival actuarial rates, increased substance abuse within this group may affect longer-term organ function, but larger studies are needed to confirm this.…”

Section: Organ Functionmentioning

confidence: 81%

Should a homeless person become a deceased organ donor?

Lee

Olivas

Apana

et al. 2019

Clinical Transplantation

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Efforts to increase deceased donation have included the use of US Public HealthService (PHS) high-risk donors. The homeless have high rates of medical and substance abuse issues that are often unrecognized. This study investigates whether the homeless should become suitable organ donors. We retrospectively reviewed 193 brain-dead prospective donors from Hawaii's organ procurement organization (OPO; 2013-2018) and compared two groups: homeless (n = 13) and non-homeless (n = 180) prospective donors. The homeless prospective donors were older (48.0 vs 40.7 years, P = .009) and had more substance abuse (30.8% vs 10%, P = .046), methamphetamine use (53.8% vs 12.2%, P = .001), cocaine use (23.1% vs 3.9%, P = .022), and urine with amphetamines (54.5% vs 17.9%, P = .049). The homeless prospective donors trended toward more PHS high-risk designation (50% vs 19%, P = .062). There was no difference in medical history, gender/race, hepatitis serologies, authorization for donation, and organs procured/transplanted between prospective donors.We have provided evidence that the homeless should become prospective organ donors; however, they have more high-risk behaviors and often have limited information. Larger studies from OPOs are needed to better characterize organ donation and track disease transmission in this population. K E Y W O R D Salcoholism and substance abuse, deceased, extended criteria, organ procurement organization 2 of 7 | LEE Et aL. chronic homelessness (≥1 year). 10 Homelessness has been shown to be an independent risk factor for increased mortality with higher rates of infection (HIV, hepatitis C, tuberculosis), heart disease, suicides, homicides, and drug overdose. [11][12][13][14] In addition, there is a higher prevalence of alcohol, smoking, and illicit substance abuse.Within the homeless population, there are particularly high mortality risk groups including those who were recently discharged from psychiatric hospitals, prisons, and the child-welfare system. 15,16 Little is known about whether homelessness would affect organ donation or increase disease transmission. Anticipated issues would include proper identification of individuals, location of next of kin, eliciting reliable medical and psychosocial histories, and obtaining authorization for donation. Limited information on recent exposures in a high-risk population may potentially increase infectious disease transmission. The only previous study showed that in 10 donor hearts from homeless donors, poorer outcomes were observed with a 50% mortality rate at 3 years post-transplantation due to elevated rates of rejection and infection. 17 In this study, we characterize deceased prospective donors who are homeless in Hawaii and evaluate whether homelessness affects disease transmission and outcome. | ME THODSThis was a retrospective study in Hawaii between 2013 and 2018. Records were obtained from Hawaii's only organ procurement organization (OPO), Legacy of Life Hawaii (LLH), and included only those brain-dead prospective organ donors. Donation after ...

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Methamphetamine use in deceased kidney donors impairs one‐yr graft function*

Abstract: Donor MA exposure may be associated with increased Cr365 in recipients. Transplant centers can expect to encounter donors with MA use histories at rates higher that regional use rates. Larger studies may demonstrate MA exposure as an independent predictor of impaired graft function.

Cited by 6 publications

References 24 publications

A Donor Utilization Index to Assess the Utilization and Discard of Deceased Donor Kidneys Perceived as High Risk

A Donor Utilization Index to Assess the Utilization and Discard of Deceased Donor Kidneys Perceived as High Risk

Hypertension, end-stage renal disease and mesangiocapillary glomerulonephritis in methamphetamine users

Should a homeless person become a deceased organ donor?

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