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Wednesday, August 6, 2014

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

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

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.




http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajt.12847

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