Kidney transplant outcomes better in patients with HIV compared with HCV, HCV/HIV confection

the Clinical Advisor take:

Patients with HIV who undergo kidney transplantation experience superior outcomes compared with patients with hepatitis C and patients with HIV and hepatitis C coinfection, study findings published in Kidney International indicate.

"HIV patients are being unfairly perceived to have worse kidney transplant outcomes than non-infected groups, and as a result, they often have to wait the longest for transplants and there are fewer living donors," noted Deirdre Sawinski, MD, of the University of Pennsylvania, in a press release.

Currently, guidelines suggest kidney transplantation as the preferred course of treatment for hepatitis C virus (HCV) patients; however, these patients experience worse outcomes compared with patients who are not infected with HCV.

To compare the effect of HIV, HCV, and HIV/HCV coinfection on kidney transplant patient and allograft outcomes, the investigators conducted a retrospective study of kidney recipients transplanted from January 1996 through December 2013. The findings represent the largest retrospective study of outcomes in adult kidney transplant recipients with HIV to date.

Of the 124,035 adult kidney transplant patients included in the study, the three-year survival rate of patients with HIV (89%) was similar compared with patients without HIV (90%). The three-year survival rates for HCV patients and HIV/HCV co-infected patients – 84% and 73%, respectively – were notably lower.

"Our hope is that these study findings result in greater access to transplantation for HIV patients, while also inspiring the kidney transplant community to focus on eradicating hepatitis C in transplant patients — either pre-transplant or if that's not possible, immediately post-transplant — to ensure better outcomes for these patients,” said Sawinski.