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Clin Transplant. 2019 May;33(5):e13532. doi: 10.1111/ctr.13532. Epub 2019 Apr 4.

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

Author information

1
Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine Miami, Florida.
2
Pharmacy Department, Jackson Memorial Hospital, Miami, Florida.
3
Department of Surgery, University of Miami Miller School of Medicine, and Miami Transplant Institute, Miami, Florida.
4
Division of Nephrology, Department of Medicine, University of Miami Miller School of Medicine Miami, Florida.
5
Division of Hepatology, Department of Medicine, University of Miami Miller School of Medicine Miami, Florida.

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

PMID:
30866102
DOI:
10.1111/ctr.13532

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