Kidney Transplant Success Varies with HIV and HCV Coinfection

By David Douglas

NEW YORK (Reuters Health) - HIV-positive patients not co-infected with hepatitis C virus (HCV) show long-term kidney transplant survival comparable to that of HIV-negative recipients.

"To date, this is the first national study examining long-term outcomes among the entire U.S. cohort of HIV-positive kidney transplant recipients. Our study demonstrates similar five- and 10-year post-transplant survival among monoinfected HIV-positive and uninfected HIV-negative recipients," Dr. Jayme E. Locke, of the University of Alabama at Birmingham, told Reuters Health by email.

In a March 19 online paper in the Journal of the American Society of Nephrology, Dr. Locke and colleagues note that kidney transplantation is now offered as a treatment option for HIV-positive patients with end-stage kidney disease.

The team examined data on 510 HIV-positive patients who underwent first-time kidney transplantation between 2002 and 2011. They were matched 1:10 with HIV-negative recipients. Median follow-up was 3.8 years in the HIV-positive group.

Overall, five- and 10-year graft survival rates were significantly lower in the HIV-positive group compared with the HIV-negative group (69.2% vs. 75.3% at five years and 49.8% vs. 54.4% at 10 years, p=0.003 and p<0.001).

However, when limited to HIV-negative/HCV-negative patients, mono-infected HIV-positive recipients had similar five-year and 10-year graft survival rates compared with uninfected recipients (75.0% vs. 75.8% at five years and 55.9% vs. 56.0% at 10 years).

Recipients who were HIV-positive and HCV-positive had a 52% graft survival at five years and 27% survival at 10 years, compared with HIV-negative/HCV-positive patients, who had 64.0% survival at five years and 36.2% survival at 10 years (p=0.01).

HIV-positive patients had similar five-year patient survival rates compared with HIV-negative patients (83.5% vs. 86.2%) but significantly lower 10-year rates (51.6% vs. 72.1%, p<0.01).

"These results are encouraging," the investigators conclude, "but do suggest caution in transplanting HIV-positive recipients co-infected with HCV, motivating future studies of survival benefit."

Dr. Locke added, "Understanding long-term outcomes among HIV-positive kidney transplant recipients is paramount to ensure continued access to life-saving kidney transplantation in this vulnerable population."

In an accompanying editorial, Drs. Alissa J. Wright, of the University of British Columbia, Vancouver, and John S. Gill, of Tufts-New England Medical Center, Boston, write that the authors "should be commended for providing a national perspective."

Dr. Wright told Reuters Health by email "This study demonstrates the excellent real-world outcomes that can be achieved in patients with HIV infection who undergo renal transplantation. However, it also highlights the acute need for different ways to study this topic as it does not provide new information on how to improve care for these patients post-transplantation, particularly those with HIV-HCV co-infection who still have very poor outcomes."

The National Institutes of Health partially supported this research. The authors reported no relevant disclosures.

SOURCE: https://bit.ly/1EOl1kY and https://bit.ly/1HxYx83

J Am Soc Nephrol 2015.

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