title: Effect of HCV, HIV and coinfection in kidney transplant recipients: mate kidney analyses.
abstract: Reports of kidney transplantation (KTX) in recipients with hepatitis C virus (HCV+), human immunodeficiency virus (HIV+) or coinfection often do not provide adequate adjustment for donor risk factors. We evaluated paired deceased-donor kidneys (derived from the same donor transplanted to different recipients) in which one kidney was transplanted into a patient with viral infection (HCV+, n = 1700; HIV+, n = 243) and the other transplanted into a recipient without infection (HCV- n = 1700; HIV- n = 243) using Scientific Registry of Transplant Recipients data between 2000 and 2013. On multivariable analysis (adjusted for recipient risk factors), HCV+ conferred increased risks of death-censored graft survival (DCGS) (adjusted hazard ratio [aHR] 1.24, 95% confidence interval [CI] 1.04-1.47) and patient survival (aHR 1.24, 95% CI 1.06-1.45) compared with HCV-. HIV+ conferred similar DCGS (aHR 0.85, 95% CI 0.48-1.51) and patient survival (aHR 0.80, 95% CI 0.39-1.64) compared with HIV-. HCV coinfection was a significant independent risk factor for DCGS (aHR 2.33; 95% CI 1.06, 5.12) and patient survival (aHR 2.88; 95% CI 1.35, 6.12). On multivariable analysis, 1-year acute rejection was not associated with HCV+, HIV+ or coinfection. Whereas KTX in HIV+ recipients were associated with similar outcomes relative to noninfected recipients, HCV monoinfection and, to a greater extent, coinfection were associated with poor patient and graft survival.
authors.affiliation: Department of Surgery, Montefiore Medical Center, Bronx, NY; Department of Surgery, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Y
authors.initials: Y
authors.lastname: Xia
authors.forename: P
authors.initials: P
authors.lastname: Friedmann
authors.forename: H
authors.initials: H
authors.lastname: Yaffe
authors.forename: J
authors.initials: J
authors.lastname: Phair
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.forename: L K
authors.initials: LK
authors.lastname: Kayler
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000601:surgery*; D006526:Hepatitis C / Q000150:complications / Q000601:surgery*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D014019:Tissue Donors
keywords: Health services and outcomes research; infection and infectious agents; kidney transplantation/nephrology; viral: hepatitis C; viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)