Retrospective study of the effects of cyclosporine in comparison with azathioprine on renal transplant recipients infected with hepatitis C virus.
A recent report noted that cyclosporine (CsA) inhibits replication of the hepatitis C virus (HCV) in vitro. Thus, CsA may be a superior immunosuppressant for renal transplant recipients infected with HCV. In the present retrospective study, we assessed whether CsA reduced the clinical impact of HCV infection among those patients. A total of 405 renal transplants were performed between 1973 and 2005, of whom we studied 189 who received CsA-based immunosuppression (CsA group) vs 108 who received an azathioprine-based regimen (AZA group). There were 44 HCVAb carriers and 145 noncarriers in the CsA group, and 41 carriers and 67 noncarriers in the AZA group. Our results showed that patient survival rate was significantly worse among HCVAb carriers than among noncarriers, as the overall survival rates were 82.9% and 90.9%, respectively, after 10 years and 71.5% and 85.7%, respectively, after 20 years (P = .0003). Patient survival rates were also significantly worse in HCVAb carriers than in noncarriers in both groups, which were 83.2% and 95.0%, respectively, after 10 years, and 74.7% and 88.8%, respectively, after 20 years (P = .0147) in the CsA group, and 82.9% and 83.6%, respectively, after 10 years and 70.7% and 80.6%, respectively, after 20 years (P = .0171) in the AZA group. Conversely, no significant difference was seen in patient survival rate for HCVAb carriers between the two groups (83.2% vs 82.9% at 10 years, and 74.7% vs 70.7% at 20 years, P = .8195). Our results confirmed that HCV infection has a negative impact on the long-term survival of renal transplant patients who receive either a CsA-based or an AZA-based regimen, suggesting that CsA does not have a positive impact on HCV carriers.
Ichikawa
Y
Y
Department of Renal Transplantation Center, Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan. yi@hp.pref.hyogo.jp
Kishikawa
H
H
Nishimura
K
K
Tokugawa
S
S
Yoshioka
I
I
Arichi
N
N
Fujii
N
N
Kyo
M
M
Nishikawa
M
M
D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D002102:Cadaver; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D019520:Living Donors; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine