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Aims: To review the Victorian increased viral risk donor (IVRD) program 22 months post-implementation. Background(s): IVRDs with at-risk behaviours for blood borne virus infection and negative nucleic acid testing (NAT) have a low absolute risk of window period infection but were historically under-utilised. A new system of allocation of these donors (defined by Public Health Service [PHS] 2013 criteria and open window periods) to pre-consented recipients was developed. Method(s): We retrospectively examined the characteristics of IVRDs (July 31 2018-May 31, 2020). Data for comparison with non-IVRDs was available for the first 7 months. Continuous data was expressed as median (IQR). Result(s): 40% of waitlisted recipients were pre-consented to accept IVRD kidneys. Thirty-two IVRDs (58 kidneys) were utilised, comprising 13.5% of all kidney donors. Only 9% of allocated IVRDs had neither kidney accepted. Injecting drug use (59%) was the commonest at-risk behaviour. NAT was performed 3 (2-4) days post-admission. 9 (28%) IVRDs had positive HCV Ab but negative NAT. 50% of recipients of these 9 IVRDs developed abnormal HCV serology, but no viraemia was detected in any IVRD recipients to date at 1 and 3 months post-transplantation. 3-month eGFR (CKD-EPI) was 65 (53-79) mL/min/1.73 m2. Compared with non-IVRDs, IVRDs were younger (37 (30-44) vs 51 (35-61) years; P < 0.01), with lower kidney donor profile index (KDPI) (26 (17-40) vs 59 (25-78); P < 0.001), and none had a KDPI >80% (0% vs 19%; P < 0.05). Waiting time was significantly shorter for blood group O IVRD vs non-IVRD recipients (26 (18-29) vs 38 (34-42) months; P = 0.001). Conclusion(s): IVRDs appear to offer better quality kidneys and may reduce waiting time with no transmission to date. Increasing the pre-consent rate may improve utilisation and benefit more waitlisted recipients.

Introduction: Increased viral risk donors (IVRDs) with at-risk behaviours for blood borne virus infection and negative nucleic acid testing (NAT) have a low absolute risk of window period infection. A program allocating these kidneys to pre-consented recipients was recently implemented in the state of Victoria, Australia. We reviewed the performance after twelve months in operation. Material(s) and Method(s): We retrospectively examined the characteristics of IVRDs (defined by Public Health Service (PHS) 2013 criteria and open window periods) (31/07/2018-31/07/2019). Data for comparison with non-IVRDs was available for the first 7 months. Kidney function, serological and NAT results of recipients at 1 and 3 months post-transplantation were analysed. Continuous data was expressed as median (IQR). Results and Discussion: 33% of waitlisted patients were pre-consented at 12 months post-implementation, increasing from 24% at 7 months. Sixteen IVRDs (28 kidneys) were utilised, comprising 12.6% of all utilised kidney donors. Risk factors included people who inject drugs (57%), increased risk sexual behaviour (31%), imprisonment (6%) and multiple risk factors (6%). NAT was performed 3.0 (1.0-4.3) days after admission. Four IVRDs had abnormal serology results (3 HCV Ab positive, 1 HBcAb and HCV Ab positive) but negative NAT. All recipients but one of HCV Ab positive IVRDs seroconverted, but no viraemia was detected in recipients from all IVRDs to date. Adherence to post-transplant surveillance testing in recipients was 85%. eGFR (CKD-EPI) was 67 (54-77) and 68 (53-81) mL/min/1.73m2 at 1 and 3 months post-transplantation. Compared with non-IVRDs, IVRDs were significantly younger (36 (28-43) versus 53 (36-61) years; P<0.01). Kidney donor profile index (KDPI) was significantly lower (21 (10-39) versus 62 (27-77); P<0.01), more likely <=20 (50% versus 18%; P<0.05) and none had a KDPI >85 (0% versus 12%; P=0.35). Waiting time was significantly shorter for blood group O recipients