HIV patients fare better than HCV patients in kidney transplant outcomes

Last Updated: 2015-04-02

By Will Boggs MD

NEW YORK (Reuters Health) - Kidney transplant outcomes are better in patients with HIV monoinfection than in patients with hepatitis C virus (HCV) monoinfection or HIV/HCV coinfection, according to results of a retrospective study.

"This study was motivated by our clinical observation that 'high risk' HIV-positive patients at our center had excellent post-transplant outcomes whereas our HCV-positive recipients did not fare the same," Dr. Deirdre Sawinski, from University of Pennsylvania, Philadelphia, told Reuters Health by email.

"We decided to look at the United Network for Organ Sharing (UNOS) data to see if this really was a nationwide trend or just unique to our center's experience. I think it is somewhat surprising exactly how well HIV-positive patients can fare after transplant and sobering how poorly HCV-positive and co-infected patients do," she said.

Dr. Sawinski and colleagues investigated outcomes in 124,035 first kidney transplant patients, including 117,791 uninfected, 5605 HCV-monoinfected, 492 HIV-monoinfected, and 147 HIV/HCV-coinfected patients.

Three-year survival rates were highest in uninfected (90%) and HIV-monoinfected (89%) patients and lowest in HCV-monoinfected (84%) and HIV/HCV-coinfected patients (73%), according to the March 25 Kidney International online report.

Allograft survival at three years was also significantly higher in the uninfected (86%) and HIV-monoinfected (81%) groups than in the HCV-monoinfected (78%) and HIV/HCV-coinfected groups (60%).

In multivariable analysis, HIV monoinfection was not associated with graft loss or death, whereas HCV monoinfection increased the risk death by 44% and graft loss by 43%, and HIV/HCV coinfection increased the risk of death 2.26-fold and graft loss 2.59-fold.

"I think that control of HIV infection pretransplant with highly active antiretroviral therapy (HAART) and partnership with an infectious disease physician is still key for the ongoing success of transplantation in these patients," Dr. Sawinski said.

"However, I would suggest that perhaps we should be more selective with our HCV-positive or co-infected recipient criteria. Pretransplant HCV eradication could play an important role in improving outcomes, especially for co-infected recipients," she said.

"I hope that our data will encourage more centers to consider these patients as candidates for transplantation and prompt more nephrologists or infectious disease specialists to refer their HIV-POSITIVE patients for transplant evaluations, ultimately resulting greater access to transplantation," Dr. Sawinski concluded. "I also hope our results will motivate more HIV-positive recipients to pursue transplantation and approach friends or family members about living donation."

Dr. Jayme E. Locke, from the University of Alabama at Birmingham's Division of Transplantation, told Reuters Health by email, "The fact that HIV-positive recipients have better outcomes than HCV-positive recipients is important and novel information."

She added, "Studies like these are critical to our understanding of long-term outcomes among HIV-positive kidney transplant patients and improved access to life saving transplantation for this vulnerable population."

The Health Research and Services Administration partially supported this research. The authors report no disclosures.

SOURCE: http://bit.ly/1CBcalX

Kidney Int 2015.