Kidney Week 2025 Annual Meeting-Increasing Kidney Transplantation: State of the Art, Including the Barbara T. Murphy, MB BAO BCh, Endowed Lectureship

Video Transcription

Video Summary

This ASN Kidney Week session on increasing kidney transplantation focused on expanding use of “medically complex” donors and donors with chronic viral infections, while improving living donation through paired kidney exchange (PKE).<br /><br />Miklos Molnar reviewed evidence supporting acceptance of higher infectious-risk organs, noting that declining such offers leads to substantial waitlist death/removal and often later transplantation with worse-quality kidneys (higher KDPI). For hepatitis C–positive donor kidneys transplanted into HCV-negative recipients, multiple strategies (transmit-and-treat, preventive, ultra-short therapy) achieve high cure rates with generally excellent graft outcomes. Concerns about fibrosing cholestatic hepatitis, BK/CMV viremia, and glomerulonephritis appear rare or not meaningfully increased, though possible higher BK nephropathy risk warrants attention. Hepatitis B–positive donor kidneys remain underutilized despite national data showing comparable long-term graft and patient survival when recipient immunity/prophylaxis is considered. For SARS-CoV-2–positive donors, studies found no kidney-to-recipient transmission and generally good outcomes, though donors dying from COVID may be associated with lower recipient GFR at six months. The HOPE Act experience shows HIV-positive donor kidneys transplanted into HIV-positive recipients have similar survival outcomes, with higher rates of HIV “breakthrough” requiring monitoring.<br /><br />Alden Doyle described systemic challenges: donor complexity rising (especially DCD), high discard/nonuse rates, regulatory uncertainty, and inefficient allocation processes. He emphasized donor centers, improved donor management, machine perfusion, and pragmatic matching of complex organs to appropriate recipients using shared decision-making.<br /><br />Robert Gaston’s Murphy Lecture argued living donation remains the gold standard but has been static for years despite surgical advances. Long-term donor ESRD risk is low but varies by subgroup; post-donation GFR may better predict risk than pre-donation measures. He highlighted “financial neutrality” (reimbursement) as essential, while incentives remain controversial.<br /><br />Amanda Leon-Bergue presented PKE as a key growth area, showing equivalent outcomes and potential cost savings. Opportunities include standardizing donor evaluation, simultaneous donor candidate evaluation, including compatible pairs, and better data infrastructure.

Asset Subtitle

Moderator(s): Beatrice Concepcion, Christina Irene Mejia

Presentation(s):

Transplant Outcomes of Kidneys from Donors with Chronic Viral Infections: Risks and Considerations - Miklos Molnar
Strategies for Accelerated Placement of Complex or Hard-to-Place Deceased Donor Kidneys - Alden Doyle
Challenging the Status Quo in Living Donation: Controversial Medical and Ethical Considerations: The Barbara T. Murphy, MB BAO BCh, Endowed Lectureship - Robert Gaston
Best Practices in Living Donor Kidney Transplantation: Optimizing Paired Kidney Exchange - Amanda Leonberg-Yoo

ASN gratefully acknowledges Verici Dx, Renalytix, and the American Society of Transplantation for supporting the Murphy Endowed Lectureship.

Note: Continuing education credits are not being offered for this session.

Meta Tag

Date 11/7/2025

Pathway 1 Kidney Transplantation

Session ID 507334

Keywords

ASN Kidney Week

kidney transplantation

medically complex donors

infectious-risk donor organs

hepatitis C positive donors

HCV-negative recipient DAA therapy

transmit-and-treat strategy

hepatitis B positive donor kidneys

SARS-CoV-2 positive donors

HOPE Act HIV-positive donor transplant

donation after circulatory death (DCD)

organ discard and nonuse rates

machine perfusion

living kidney donation

paired kidney exchange (PKE)