Reuters Health Information: HCV, not HIV, associated with inferior kidney transplant outcome
HCV, not HIV, associated with inferior kidney transplant outcome
Last Updated: 2014-08-01
By Megan Brooks
NEW YORK (Reuters Health) - HIV infection does not affect
kidney transplant graft or patient outcomes but hepatitis C
virus (HCV) infection has a negative impact on both, according
to a study by researchers from the Penn Transplant Institute at
the University of Pennsylvania in Philadelphia.
The researchers say pretransplant HCV eradication should be
a priority to improve outcomes in this population.
Dr. Deidre Sawinski reported the study findings during a
July 30 Plenary Session at the 2014 World Transplant Congress on
In an interview with Reuters Health, she said their research
was motivated by a clinical observation.
"We noticed in our practice that a lot of HIV-positive
kidney transplant recipients had excellent outcomes, but
unfortunately, a lot of our hepatitis C patients over time lost
their grafts and some patients died," she explained.
So the Penn team looked beyond their own practice to the
United Network for Organ Sharing (UNOS) database, which collects
information on all transplants across the country, and confirmed
that what they were seeing is happening across the country.
They compared the effect of HIV, HCV, or HIV/HCV
co-infection on kidney transplant outcomes in patients
transplanted between 1996 and 2012.
They examined patient and overall graft survival in 429
HIV-positive patients, 5145 HCV-positive patients, 129 HIV/HCV
co-infected patients and 106,288 HIV-negative/HCV-negative
patients (reference population).
They found that patient and graft survival in the
HIV-positive group did not differ markedly from the reference
population and was superior to both HCV-positive and
The hazard ratios for graft loss and death were 1.41 and
1.53 in HCV-positive patients, compared with 1.13 and 1.31 in
HIV-positive patients, and 2.58 and 3.28 in HIV/HCV co-infected
"The key findings are that HIV-positive patients did not
have a difference in their outcomes compared to uninfected
recipients, for either patient or kidney survival," Dr. Sawinski
said, "but that hep C patients did worse than the HIV patients
or uninfected normals. And the unfortunate finding is that
patients who are co-infected did the absolute worse in terms of
patient and graft survival."
Dr. Sawinski said the stigma of HIV in the transplant field
provided another motivation for the study.
"There still is a lot of stigma for patients with HIV, they
definitely have decreased access to transplantation. Only about
a quarter of centers will be willing to take them on as
transplant recipients and we thought that this was unjustified,"
she told Reuters Health. "These patients are perceived to be
very high risk but if anything our data shows that they are not,
and that hep C patients, which pretty much any center will
transplant without a second thought, actually probably are more
high risk than the HIV folks."
Dr. Sawinksi said more study is needed to figure out why HCV
patients do worse, "whether this is due to uncontrolled hep C,
or are we as physicians perhaps too cautious in our use of
immunosuppression in these patients because we worry about their
hep C getting out of control."
She also told Reuters Health, "The study has caused us to
look more closely at our co-infected recipients and perhaps be
more selective but it's also motivated us as a center to try to
get more actively involved in trials of new hep C direct-acting
antivirals in dialysis patients. Currently, there is an FDA
warning that patients who have kidney function less than 30% and
who are on dialysis are not supposed to be treated with these
new hep C therapies because there is no dosing information."
Trials are needed to figure out appropriate dosing in these
patients, she added.