Effect of HCV, HIV and coinfection in kidney transplant recipients: Mate kidney analyses

Y. Xia, P. Friedmann, H. Yaffe, J. Phair, A. Gupta, L. K. Kayler

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

Reports of kidney transplantation (KTX) in recipients with hepatitis C virus (HCV+), human immunodeficiency virus (HIV+) 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 (HCV+, n = 1700; HIV+, n = 243) and the other transplanted into a recipient without infection (HCV- n = 1700; HIV- n = 243) using Scientific Registry of Transplant Recipients data between 2000 and 2013. On multivariable analysis (adjusted for recipient risk factors), HCV+ 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 HCV-. HIV+ 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 HIV-. 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 HCV+, HIV+ or coinfection. Whereas KTX in HIV+ 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. Two analyses using Scientific Registry of Transplant Recipients data of paired deceased-donor kidneys in which one kidney was transplanted into a patient with viral infection and the other transplanted to a recipient without infection demonstrates that whereas kidney transplantation in recipients with HIV was associated with similar outcomes relative to noninfected recipients, hepatitis C monoinfection and to a greater extent coinfection were associated with poor patient and graft survival. See editorial by Terrault and Stock on page 1955.

Original languageEnglish (US)
Pages (from-to)2037-2047
Number of pages11
JournalAmerican Journal of Transplantation
Volume14
Issue number9
DOIs
StatePublished - Sep 2014

Keywords

  • Health services and outcomes research
  • infection and infectious agents
  • kidney transplantation/nephrology
  • viral: hepatitis C
  • viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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