Effect of HCV, HIV and Coinfection in Kidney Transplant Recipients: Mate Kidney Analyses

Abstract

Reports of kidney transplantation (KTX) in recipients with hepatitis C virus (HCVþ), human immunodeficiency virus (HIVþ) or coinfection often do not provide adequate adjustment for donor risk factors. We evaluated paired deceased-donor kidneys (derived from the same donor transplanted to different recipients) in which one kidney was transplanted into a patient with viral infection (HCVþ, n ¼ 1700; HIVþ, n ¼ 243) and the other transplanted into a recipient without infection (HCVÀ n ¼ 1700; HIVÀ n ¼ 243) using Scientific Registry of Transplant Recipients data between 2000 and 2013. On multivariable analysis (adjusted for recipient risk factors), HCVþ conferred increased risks of death-censored graft survival (DCGS) (adjusted hazard ratio [aHR] 1.24, 95% confidence interval [CI] 1.04-1.47) and patient survival (aHR 1.24, 95% CI 1.06-1.45) compared with HCVÀ. HIVþ conferred similar DCGS (aHR 0.85, 95% CI 0.48-1.51) and patient survival (aHR 0.80, 95% CI 0.39-1.64) compared with HIVÀ. HCV coinfection was a significant independent risk factor for DCGS (aHR 2.33; 95% CI 1.06, 5.12) and patient survival (aHR 2.88; 95% CI 1. 35, 6.12). On multivariable analysis, 1-year acute rejection was not associated with HCVþ, HIVþ or coinfection. Whereas KTX in HIVþ recipients were associated with similar outcomes relative to noninfected recipients, HCV monoinfection and, to a greater extent, coinfection were associated with poor patient and graft survival.

Update on kidney transplantation in human immunodeficiency virus infected recipients

“…Mate kidney analyses using SRTR database from 2000 to 2013 showed similar long term outcomes of kidney transplantation in HIV positive patients relative to noninfected recipients. HIV and HCV coinfected patients had inferior outcomes in this analysis [20] . European transplant centers have similar experience to that in the United States.…”

“…As mentioned, outcomes were inferior with kidney transplantation in patients coinfected with HIV and HCV when compared to HIV monoinfected transplant recipients [19,20] . Factors contributing to this may include HCV infection related increased risk for the development of post-transplant diabetes mellitus, liver damage, cardiovascular disease and infections.…”

“…Coinfected patients may represent a social and biological high risk group. For instance, these patients generally are younger with lower income, have longer HIV disease duration and dialysis vintage prior to transplantation with greater likelihood of drug addiction history [20] . This raises the question whether HCV coinfection should be a relative contraindication for kidney transplantation in HIV positive patients.…”

En Bloc Multivisceral and Kidney Transplantation in an HIV Patient: First Case Report

“…Despite the proven immunoprotective effect of simultaneously transplanted liver, the intestinal allograft experienced significant histopathologic damage (11,18). Dysregulation of the innate immune response due to HIV infection may also have contributed to the observed higher risk of destructive alloimmunity as observed with solid organs (2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). It is also possible that ischemic injury upregulated the allogeneic response.…”

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“…2,3 Hepatitis C virus infection has negative effects on both patient and graft survival. 2,4,5 A meta-analysis demonstrated that the presence of HCV antibodies was an independent and significant risk factor for death (risk ratio = 1.79; 95% confidence interval [CI], 1.57-2.03; P = .042) and graft failure (risk ratio = 1.56; 95% CI, 1.35-1.80; P = .019) after kidney transplant. 6 The lower survival was related to the posttransplant progression of liver disease induced by the use of immunosuppressive regimens 7,8 and increased risk for development of extrahepatic complications of HCV infection, including posttransplant de novo or recurrent glomerular disease and new-onset diabetes mellitus.…”