Clinical outcomes in HIV+/HCV+ coinfected kidney transplant recipients in the pre- and post-direct-acting antiviral therapy eras: 10-Year single center experience

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Previous studies have demonstrated inferior patient and graft survival following kidney transplant (KT) in HIV+/HCV+ coinfected patients compared to HIV+/HCV− recipients. However, these studies were conducted prior to the availability of direct-acting antiviral (DAA) agents and data in the modern era are lacking. Methods: Single center retrospective study of HIV+/HCV+ coinfected KT recipients (2007-2017). Outcomes were assessed for the pre-DAA and post-DAA (ie, after December 2013) eras including 1-year patient survival, death-censored graft survival, and acute rejection; and serious infections (defined as infections requiring admission to the intensive care unit during initial transplant hospitalization or re-admission to the hospital after discharge) within the first 6 months post-transplant. Results: A total of 13 consecutive HIV+/HCV+ recipients were identified. Median time of post-transplant follow-up was 722 days. Seven patients were transplanted in the DAA era; five of them had anti-HCV Ab+ donors, with two donors being HCV NAT positive; all received DAA therapy, six of them post-transplant (median time from KT to DAA: 83 days; IQR, 54-300). All the patients in the pre-DAA era were on a protease inhibitor-containing ART regimen. One-year patient and death-censored graft survivals were 83% and 67%, respectively, for the patients transplanted in the pre-DAA era, and 100% for both outcomes in the subgroup of patients transplanted in the post-DAA era (P > 0.05). Compared to patients in the post-DAA era, those in the pre-DAA era had higher incidence of serious infections (0 vs 67%; P = 0.02). Acute rejection exclusively occurred in the pre-DAA group (n = 1; 17%). Conclusions: Outcomes of HIV+/HCV+ KT recipients, including HIV−/HCV+ to HIV+/HCV+ transplants, in the DAA era were excellent in this small cohort. Larger studies are needed.

Original languageEnglish (US)
Article numbere13532
JournalClinical Transplantation
DOIs
StatePublished - Jan 1 2019

Fingerprint

Antiviral Agents
HIV
Kidney
Transplants
Therapeutics
Graft Survival
Transplant Recipients
Infection
Tissue Donors
Protease Inhibitors
Intensive Care Units
Hospitalization
Retrospective Studies
Survival

Keywords

  • coinfection
  • direct-acting antivirals
  • hepatitis C virus
  • human immunodeficiency virus
  • kidney transplant

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{e138adfb92d94fef835fb895f14c0166,
title = "Clinical outcomes in HIV+/HCV+ coinfected kidney transplant recipients in the pre- and post-direct-acting antiviral therapy eras: 10-Year single center experience",
abstract = "Background: Previous studies have demonstrated inferior patient and graft survival following kidney transplant (KT) in HIV+/HCV+ coinfected patients compared to HIV+/HCV− recipients. However, these studies were conducted prior to the availability of direct-acting antiviral (DAA) agents and data in the modern era are lacking. Methods: Single center retrospective study of HIV+/HCV+ coinfected KT recipients (2007-2017). Outcomes were assessed for the pre-DAA and post-DAA (ie, after December 2013) eras including 1-year patient survival, death-censored graft survival, and acute rejection; and serious infections (defined as infections requiring admission to the intensive care unit during initial transplant hospitalization or re-admission to the hospital after discharge) within the first 6 months post-transplant. Results: A total of 13 consecutive HIV+/HCV+ recipients were identified. Median time of post-transplant follow-up was 722 days. Seven patients were transplanted in the DAA era; five of them had anti-HCV Ab+ donors, with two donors being HCV NAT positive; all received DAA therapy, six of them post-transplant (median time from KT to DAA: 83 days; IQR, 54-300). All the patients in the pre-DAA era were on a protease inhibitor-containing ART regimen. One-year patient and death-censored graft survivals were 83{\%} and 67{\%}, respectively, for the patients transplanted in the pre-DAA era, and 100{\%} for both outcomes in the subgroup of patients transplanted in the post-DAA era (P > 0.05). Compared to patients in the post-DAA era, those in the pre-DAA era had higher incidence of serious infections (0 vs 67{\%}; P = 0.02). Acute rejection exclusively occurred in the pre-DAA group (n = 1; 17{\%}). Conclusions: Outcomes of HIV+/HCV+ KT recipients, including HIV−/HCV+ to HIV+/HCV+ transplants, in the DAA era were excellent in this small cohort. Larger studies are needed.",
keywords = "coinfection, direct-acting antivirals, hepatitis C virus, human immunodeficiency virus, kidney transplant",
author = "Camargo, {Jose F.} and Shweta Anjan and Nafeesa Chin-Beckford and Morris, {Michele I.} and Abbo, {Lilian M.} and Jacques Simkins and Gaetano Ciancio and Chen, {Linda J.} and Burke, {George W.} and Jose Figueiro and Giselle Guerra and Kupin, {Warren L.} and Adela Mattiazzi and Mariella Ortigosa-Goggins and {Ram Bhamidimarri}, Kalyan and David Roth",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/ctr.13532",
language = "English (US)",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Clinical outcomes in HIV+/HCV+ coinfected kidney transplant recipients in the pre- and post-direct-acting antiviral therapy eras

T2 - 10-Year single center experience

AU - Camargo, Jose F.

AU - Anjan, Shweta

AU - Chin-Beckford, Nafeesa

AU - Morris, Michele I.

AU - Abbo, Lilian M.

AU - Simkins, Jacques

AU - Ciancio, Gaetano

AU - Chen, Linda J.

AU - Burke, George W.

AU - Figueiro, Jose

AU - Guerra, Giselle

AU - Kupin, Warren L.

AU - Mattiazzi, Adela

AU - Ortigosa-Goggins, Mariella

AU - Ram Bhamidimarri, Kalyan

AU - Roth, David

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Previous studies have demonstrated inferior patient and graft survival following kidney transplant (KT) in HIV+/HCV+ coinfected patients compared to HIV+/HCV− recipients. However, these studies were conducted prior to the availability of direct-acting antiviral (DAA) agents and data in the modern era are lacking. Methods: Single center retrospective study of HIV+/HCV+ coinfected KT recipients (2007-2017). Outcomes were assessed for the pre-DAA and post-DAA (ie, after December 2013) eras including 1-year patient survival, death-censored graft survival, and acute rejection; and serious infections (defined as infections requiring admission to the intensive care unit during initial transplant hospitalization or re-admission to the hospital after discharge) within the first 6 months post-transplant. Results: A total of 13 consecutive HIV+/HCV+ recipients were identified. Median time of post-transplant follow-up was 722 days. Seven patients were transplanted in the DAA era; five of them had anti-HCV Ab+ donors, with two donors being HCV NAT positive; all received DAA therapy, six of them post-transplant (median time from KT to DAA: 83 days; IQR, 54-300). All the patients in the pre-DAA era were on a protease inhibitor-containing ART regimen. One-year patient and death-censored graft survivals were 83% and 67%, respectively, for the patients transplanted in the pre-DAA era, and 100% for both outcomes in the subgroup of patients transplanted in the post-DAA era (P > 0.05). Compared to patients in the post-DAA era, those in the pre-DAA era had higher incidence of serious infections (0 vs 67%; P = 0.02). Acute rejection exclusively occurred in the pre-DAA group (n = 1; 17%). Conclusions: Outcomes of HIV+/HCV+ KT recipients, including HIV−/HCV+ to HIV+/HCV+ transplants, in the DAA era were excellent in this small cohort. Larger studies are needed.

AB - Background: Previous studies have demonstrated inferior patient and graft survival following kidney transplant (KT) in HIV+/HCV+ coinfected patients compared to HIV+/HCV− recipients. However, these studies were conducted prior to the availability of direct-acting antiviral (DAA) agents and data in the modern era are lacking. Methods: Single center retrospective study of HIV+/HCV+ coinfected KT recipients (2007-2017). Outcomes were assessed for the pre-DAA and post-DAA (ie, after December 2013) eras including 1-year patient survival, death-censored graft survival, and acute rejection; and serious infections (defined as infections requiring admission to the intensive care unit during initial transplant hospitalization or re-admission to the hospital after discharge) within the first 6 months post-transplant. Results: A total of 13 consecutive HIV+/HCV+ recipients were identified. Median time of post-transplant follow-up was 722 days. Seven patients were transplanted in the DAA era; five of them had anti-HCV Ab+ donors, with two donors being HCV NAT positive; all received DAA therapy, six of them post-transplant (median time from KT to DAA: 83 days; IQR, 54-300). All the patients in the pre-DAA era were on a protease inhibitor-containing ART regimen. One-year patient and death-censored graft survivals were 83% and 67%, respectively, for the patients transplanted in the pre-DAA era, and 100% for both outcomes in the subgroup of patients transplanted in the post-DAA era (P > 0.05). Compared to patients in the post-DAA era, those in the pre-DAA era had higher incidence of serious infections (0 vs 67%; P = 0.02). Acute rejection exclusively occurred in the pre-DAA group (n = 1; 17%). Conclusions: Outcomes of HIV+/HCV+ KT recipients, including HIV−/HCV+ to HIV+/HCV+ transplants, in the DAA era were excellent in this small cohort. Larger studies are needed.

KW - coinfection

KW - direct-acting antivirals

KW - hepatitis C virus

KW - human immunodeficiency virus

KW - kidney transplant

UR - http://www.scopus.com/inward/record.url?scp=85063951184&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063951184&partnerID=8YFLogxK

U2 - 10.1111/ctr.13532

DO - 10.1111/ctr.13532

M3 - Article

C2 - 30866102

AN - SCOPUS:85063951184

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

M1 - e13532

ER -