Kidney transplantation in hepatitis C-positive recipients: does type of induction influence outcomes?
BACKGROUND
Kidney transplantation in hepatitis C virus-seropositive (HCV+) recipients improves survival compared to staying on the waiting list. A concern for using depleting (versus nondepleting) induction agent during kidney transplantation in HCV+ recipients is the possibility that the associated enhanced immunosuppression might favor the progression of hepatitis C infection, leading to adverse outcomes.


METHODS
Utilizing data from the Organ Procurement and Transplant Network, we identified HCV+ patients ≥ 18 years of age who underwent deceased donor kidney (DDK) transplants from either HCV+ or HCV- donors between 1998 and 2008. Patients were divided into two groups based on the induction type they received during the transplant: depleting agent (rabbit-antithymocyte globulin or alemtuzumab) or nondepleting agent (basiliximab or daclizumab) groups. Unadjusted and adjusted graft and patient survivals (Cox regression) between the groups were compared.


RESULTS
A total of 3490 HCV+ DDK recipients were identified (1859 in the depleting and 1631 in the nondepleting groups). When compared to nondepleting agent, adjusted graft (hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.96-1.28, P = .16) and patient (HR 1.15, 95% CI 0.93-1.42, P = .2) survivals were similar with depleting agent induction. HCV donor seropositivity did not adversely impact either graft (HR 1.11, 95% CI 0.96-1.29, P = .17) or patient (HR 1.15, 95% CI 0.93-1.42, P = .2) outcomes.


CONCLUSIONS
Our analysis supports the practice of transplanting HCV+ donor kidneys into HCV+ recipients to alleviate waiting list burden. Recipient HCV positivity should not influence selection of induction agent.
Department of Medicine, Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
K K
KK
Sureshkumar
N L
NL
Thai
R J
RJ
Marcus
D000328:Adult; D018450:Disease Progression; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007674:Kidney Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists; D055815:Young Adult
D007166:Immunosuppressive Agents