Campath induction in HCV and HCV/HIV-seropositive kidney transplant recipients

Marcelo Vivanco, Patricia Friedmann, Yu Xia, Tarunjeet Klair, Kwaku Marfo, Graciela De Boccardo, Stuart M. Greenstein, Javier Chapochnick-Friedmann, Milan Kinkhabwala, Maria Ajaimy, Michelle L. Lubetzky, Enver Akalin, Liise K. Kayler

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Alemtuzumab (AZ) induction in hepatitis C-seropositive (HCV+) kidney transplant (KTX) recipients may negatively affect patient survival; however, available information is scant. Using US registry data from 2003 to 2010 of adult HCV+ deceased-donor KTXs (n = 4910), we examined outcomes by induction agent - AZ (n = 294), other T cell-depleting agents, (n = 2033; T cell), IL-2 receptor blockade (n = 1135; IL-2RAb), and no induction (n = 1448). On multivariate analysis, induction therapy was associated with significantly better overall patient survival with AZ [adjusted hazards ratio (aHR) 0.64, 95% confidence interval (CI) 0.45, 0.92], T cell (aHR 0.52, 95% CI 0.41, 0.65) or IL-2RAb (aHR 0.67, 95% CI 0.53, 0.87), compared to no induction. A significant protective effect was also seen with AZ (aHR 0.63, 95% CI 0.40, 0.99), T cell (aHR 0.62, 95% CI 0.49, 0.78), and IL2R-Ab (aHR 0.62, 95% CI 0.47, 0.82) in terms of death-censored graft survival relative to no induction. There were 88 HIV+/HCV+ coinfected recipients. Compared to noninduction, any induction (i.e. three induction groups combined) was associated with similar overall patient survival (P = 0.2255) on univariate analysis. Induction therapy with AZ, other T cell-depleting agents, or IL-2RAb in HCV+ KTX is associated with better patient and death-censored graft survival compared to noninduction. In HCV/HIV coinfected patients, induction is not contraindicated.

Original languageEnglish (US)
Pages (from-to)1016-1026
Number of pages11
JournalTransplant International
Volume26
Issue number10
DOIs
StatePublished - Oct 2013

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HIV
Confidence Intervals
Kidney
T-Lymphocytes
Graft Survival
Survival
Interleukin-2 Receptors
Hepatitis C
Registries
alemtuzumab
Transplant Recipients
Multivariate Analysis
Tissue Donors
Therapeutics

Keywords

  • alemtuzumab
  • kidney transplantation
  • patient survival

ASJC Scopus subject areas

  • Transplantation

Cite this

Vivanco, M., Friedmann, P., Xia, Y., Klair, T., Marfo, K., De Boccardo, G., ... Kayler, L. K. (2013). Campath induction in HCV and HCV/HIV-seropositive kidney transplant recipients. Transplant International, 26(10), 1016-1026. https://doi.org/10.1111/tri.12167

Campath induction in HCV and HCV/HIV-seropositive kidney transplant recipients. / Vivanco, Marcelo; Friedmann, Patricia; Xia, Yu; Klair, Tarunjeet; Marfo, Kwaku; De Boccardo, Graciela; Greenstein, Stuart M.; Chapochnick-Friedmann, Javier; Kinkhabwala, Milan; Ajaimy, Maria; Lubetzky, Michelle L.; Akalin, Enver; Kayler, Liise K.

In: Transplant International, Vol. 26, No. 10, 10.2013, p. 1016-1026.

Research output: Contribution to journalArticle

Vivanco, M, Friedmann, P, Xia, Y, Klair, T, Marfo, K, De Boccardo, G, Greenstein, SM, Chapochnick-Friedmann, J, Kinkhabwala, M, Ajaimy, M, Lubetzky, ML, Akalin, E & Kayler, LK 2013, 'Campath induction in HCV and HCV/HIV-seropositive kidney transplant recipients', Transplant International, vol. 26, no. 10, pp. 1016-1026. https://doi.org/10.1111/tri.12167
Vivanco, Marcelo ; Friedmann, Patricia ; Xia, Yu ; Klair, Tarunjeet ; Marfo, Kwaku ; De Boccardo, Graciela ; Greenstein, Stuart M. ; Chapochnick-Friedmann, Javier ; Kinkhabwala, Milan ; Ajaimy, Maria ; Lubetzky, Michelle L. ; Akalin, Enver ; Kayler, Liise K. / Campath induction in HCV and HCV/HIV-seropositive kidney transplant recipients. In: Transplant International. 2013 ; Vol. 26, No. 10. pp. 1016-1026.
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abstract = "Alemtuzumab (AZ) induction in hepatitis C-seropositive (HCV+) kidney transplant (KTX) recipients may negatively affect patient survival; however, available information is scant. Using US registry data from 2003 to 2010 of adult HCV+ deceased-donor KTXs (n = 4910), we examined outcomes by induction agent - AZ (n = 294), other T cell-depleting agents, (n = 2033; T cell), IL-2 receptor blockade (n = 1135; IL-2RAb), and no induction (n = 1448). On multivariate analysis, induction therapy was associated with significantly better overall patient survival with AZ [adjusted hazards ratio (aHR) 0.64, 95{\%} confidence interval (CI) 0.45, 0.92], T cell (aHR 0.52, 95{\%} CI 0.41, 0.65) or IL-2RAb (aHR 0.67, 95{\%} CI 0.53, 0.87), compared to no induction. A significant protective effect was also seen with AZ (aHR 0.63, 95{\%} CI 0.40, 0.99), T cell (aHR 0.62, 95{\%} CI 0.49, 0.78), and IL2R-Ab (aHR 0.62, 95{\%} CI 0.47, 0.82) in terms of death-censored graft survival relative to no induction. There were 88 HIV+/HCV+ coinfected recipients. Compared to noninduction, any induction (i.e. three induction groups combined) was associated with similar overall patient survival (P = 0.2255) on univariate analysis. Induction therapy with AZ, other T cell-depleting agents, or IL-2RAb in HCV+ KTX is associated with better patient and death-censored graft survival compared to noninduction. In HCV/HIV coinfected patients, induction is not contraindicated.",
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