title: Excessive immunosuppression as a potential cause of poor survival in simultaneous liver/kidney transplantation for hepatitis C.
abstract: Appropriate recipient selection of simultaneous liver/kidney transplantation (SLKT) remains controversial. In particular, data on liver graft survival in hepatitis C virus-infected (HCV+) SLKT recipients are lacking. We conducted a single-center, retrospective study of HCV+ SLKT recipients (N = 25) in comparison with HCV- SLKT (N = 26) and HCV+ liver transplantation alone (LTA, N = 296). Despite backgrounds of HCV+ and HCV- SLKT being similar, HCV+ SLKT demonstrated significantly impaired 5-year liver graft survival of 35% (HCV- SLKT, 79%, P = 0.004). Compared with HCV+ LTA, induction immunosuppression was more frequently used in HCV+ SLKT. Five-year liver graft survival rate for HCV+ SLKT was significantly lower than that for LTA (35% vs. 74%, respectively, P < 0.001). Adjusted hazard ratio of liver graft loss in HCV+ SLKT was 4.9 (95% confidence interval 2.0-12.1, P = 0.001). HCV+ SLKT recipients were more likely to succumb to recurrent HCV and sepsis compared with LTA (32% vs. 8.8%, P < 0.001 and 24% vs. 8.8%, P = 0.030, respectively). Ten HCV+ SLKT recipients underwent anti-HCV therapy for recurrent HCV; only 1 achieved sustained virological response. HCV+ SLKT is associated with significantly decreased long-term prognosis compared with HCV- SLKT and HCV+ LTA.
authors.affiliation: Miami Transplant Institute, University of Miami Leonard M. Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA; DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA; Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Taizo
authors.initials: T
authors.lastname: Hibi
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Junichiro
authors.initials: J
authors.lastname: Sageshima
authors.forename: David M
authors.initials: DM
authors.lastname: Levi
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: David
authors.initials: D
authors.lastname: Roth
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
authors.forename: Koji
authors.initials: K
authors.lastname: Okabayashi
authors.forename: George W
authors.initials: GW
authors.lastname: Burke
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ciancio
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D000704:Analysis of Variance; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods / Q000401:mortality*; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014181:Transplantation Immunology / Q000276:immunology* / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: antiviral treatment; graft survival; hepatitis C; induction immunosuppression; patient survival; simultaneous liver/kidney transplantation