1
|
Puntiel DA, Prudencio TM, Peticca B, Stanicki B, Liss J, Egan N, Di Carlo A, Chavin K, Karhadkar SS. Beyond Immunity: Challenges in Kidney Retransplantation Among Persons Living With HIV. J Surg Res 2024; 303:50-56. [PMID: 39298938 DOI: 10.1016/j.jss.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/29/2024] [Accepted: 08/17/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION While superb outcomes have been observed in the HIV-positive (HIV+) population, graft failure and subsequent need for kidney retransplantation (re-KT) remain a concern. This study aims to investigate the difference in success rates of re-KT allograft survival in the HIV+ versus HIV-negative (HIV-) population in the current era of transplantation (2014-2022). METHODS Data was collected from the Organ Procurement and Transplantation Network on all kidney transplant donors and recipients who had their first re-KT between 2014 and 2022. Allograft survival was assessed using Kaplan-Meier analysis with a log-rank test, while risk factors for graft loss were assessed using Cox proportional hazards with statistical significance set to P = 0.05. RESULTS HIV+ recipients were significantly more likely to be Black (P < 0.001), have an HLA mismatch >3 (P = 0.018), delayed graft function (P = 0.023), and graft loss from primary nonfunction (P < 0.001). Their HIV- counterparts were more likely to be White (P < 0.001) and Hispanic (<0.001), lose their graft from acute rejection (P = 0.044), and have a living donor (P = 0.001). Being HIV+ was associated with a 1.68-fold increased risk of graft loss, an HLA mismatch >3 held a 1.18-fold increase, experiencing delayed graft function held a 1.89-fold increase, and having diabetes was associated with a 1.16-fold increased risk. Living donor kidneys were associated with a 15.8% decrease in risk for graft failure. Kaplan-Meier curves showed a significantly lower duration of kidney allograft survival in the HIV+ community (P = 0.02). CONCLUSIONS Disproportional graft failure and inadequate HLA mismatching persist within the HIV+ Re-KT community. Stronger organ matching and new approaches for desensitizing retransplant candidates are vital.
Collapse
Affiliation(s)
- Dante A Puntiel
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Tomas M Prudencio
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Benjamin Peticca
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Brooke Stanicki
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Jacob Liss
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Nicolas Egan
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Antonio Di Carlo
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Kenneth Chavin
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Sunil S Karhadkar
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
| |
Collapse
|
2
|
Goetsch MR, Tamhane A, Overton ET, Towns GC, Franco RA. Direct Acting Antivirals in Hepatitis C-Infected Kidney Transplant Recipients: Associations with Long-term Graft Failure and Patient Mortality. Pathog Immun 2020; 5:275-290. [PMID: 33089036 PMCID: PMC7556425 DOI: 10.20411/pai.v5i1.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/21/2020] [Indexed: 02/06/2023] Open
Abstract
Background Direct-acting antiviral (DAA) therapy among hepatitis C virus (HCV)-infected kidney transplant recipients is associated with short-term improvement in protein/creatinine (P/C) ratios, but how HCV cure affects long-term graft outcomes remains unknown. Methods This is a retrospective follow-up study of 59 HCV-infected patients who underwent kidney transplant at the University of Alabama at Birmingham between 2007-2015 who were followed until the end of 2017. We examined the association of DAA-induced HCV cure with graft failure or death by survival analyses (Kaplan-Meier, Cox regression). Results Mean age was 55 years, 73% were African American, and 68% were male. Median baseline creatinine was 1.4 mg/dL, P/C ratio was 0.5, and estimated glomerular filtration rate (eGFR) was 59 mL/min. Of those who received DAA, 24 (83%) achieved cure. The remaining 5 DAA patients (17%) did not have documented evidence of sustained virologic response (SVR). Overall, 19 (32%) patients experienced graft failure or death; with lower incidence in treated patients than untreated (4 vs 15 events; 2.6 vs 10.3 per 100 person-years [cHR 0.19, 95% CI: 0.06-0.66]). When adjusted for age, sex, race, and proteinuria, the association remained strong and invariant across time-varying (aHR 0.30, 95% CI: 0.08-1.10), time-averaged (aHR 0.28, 95% CI: 0.07-1.07), and time-varying-cumulative (aHR 0.32, 95% CI: 0.08-1.21) proteinuria metrics. Conclusions DAAs therapy was associated with improved graft survival and reduced mortality. While not statistically significant, the association was strong, and these single-center findings warrant larger studies to demonstrate the benefits of HCV treatment in this population.
Collapse
Affiliation(s)
| | - Ashutosh Tamhane
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Edgar T Overton
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Graham C Towns
- Department of Medicine, Division of Nephrology, University of Alabama School of Medicine, Birmingham, Alabama
| | - Ricardo A Franco
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
3
|
Successful Kidney Transplantation in a Recipient Coinfected with Hepatitis C Genotype 2 and HIV from a Donor Infected with Hepatitis C Genotype 1 in the Direct-Acting Antiviral Era. Case Reports Hepatol 2020; 2020:7679147. [PMID: 32082657 PMCID: PMC7011348 DOI: 10.1155/2020/7679147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/03/2020] [Indexed: 12/01/2022] Open
Abstract
Despite significant advances in transplantation of HIV-infected individuals, little is known about HIV coinfected patients with hepatitis C virus (HCV) genotypes other than genotype 1, especially when receiving HCV-infected organs with a different genotype. We describe the first case of kidney transplantation in a man coinfected with hepatitis C and HIV in our state. To our knowledge, this is also the first report of an HIV/HCV/HBV tri-infected patient with non-1 (2a) HCV genotype who received an HCV-infected kidney graft with the discordant genotype (1a), to which he converted after transplant. Our case study highlights the following: (1) transplant centers need to monitor wait times for an HCV-infected organ and regularly assess the risk of delaying HCV antiviral treatment for HCV-infected transplant candidates in anticipation of the transplant from an HCV-infected donor; (2) closer monitoring of tacrolimus levels during the early phases of anti-HCV protease inhibitor introduction and discontinuation may be indicated; (3) donor genotype transmission can occur; (4) HIV/HCV coinfected transplant candidates require a holistic approach with emphasis on the cardiovascular risk profile and low threshold for cardiac catheterization as part of their pretransplant evaluation.
Collapse
|
4
|
Changes in Utilization and Discard of HCV Antibody-Positive Deceased Donor Kidneys in the Era of Direct-Acting Antiviral Therapy. Transplantation 2019; 102:2088-2095. [PMID: 29912046 DOI: 10.1097/tp.0000000000002323] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The availability of direct-acting antiviral (DAA) therapy might have impacted use of hepatitis C virus (HCV)-infected (HCV+) deceased donor kidneys for transplantation. METHODS We used 2005 to 2018 Scientific Registry of Transplant Recipients data to identify 18 936 candidates willing to accept HCV+ kidneys and 3348 HCV+ recipients of HCV+ kidneys. We compared willingness to accept, utilization, discard, and posttransplant outcomes associated with HCV+ kidneys between 2 treatment eras (interferon [IFN] era, January 1, 2005 to December 5, 2013 vs DAA era, December 6, 2013 to August 2, 2018). Models were adjusted for candidate, recipient, and donor factors where appropriate. RESULTS In the DAA era, candidates were 2.2 times more likely to list as willing to accept HCV+ kidneys (adjusted odds ratio, 2.072.232.41; P < 0.001), and HCV+ recipients were 1.95 times more likely to have received an HCV+ kidney (adjusted odds ratio, 1.761.952.16; P < 0.001). Median Kidney Donor Profile Index of HCV+ kidneys decreased from 77 (interquartile range [IQR], 59-90) in 2005 to 53 (IQR, 40-67) in 2017. Kidney Donor Profile Index of HCV- kidneys remained unchanged from 45 (IQR, 21-74) to 47 (IQR, 24-73). After adjustment, HCV+ kidneys were 3.7 times more likely to be discarded than HCV- kidneys in the DAA era (adjusted relative rate, 3.363.674.02; P < 0.001); an increase from the IFN era (adjusted relative rate, 2.783.023.27; P < 0.001). HCV+ kidney use was concentrated within a subset of centers; 22.5% of centers performed 75% of all HCV+ kidney transplants in the DAA era. Mortality risk associated with HCV+ kidneys remained unchanged (aHR, 1.071.191.32 in both eras). CONCLUSIONS Given the elevated risk of death on dialysis facing HCV+ candidates, improving quality of HCV+ kidneys, and DAA availability, broader utilization of HCV+ kidneys is warranted to improve access in this era of organ shortage.
Collapse
|
5
|
Cohen-Bucay A, Francis JM, Gordon CE. Timing of hepatitis C virus infection treatment in kidney transplant candidates. Hemodial Int 2019; 22 Suppl 1:S61-S70. [PMID: 29694723 DOI: 10.1111/hdi.12643] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hepatitis C virus (HCV) infection is prevalent in patients with kidney disease including transplant candidates and recipients. It is associated with increased morbidity and mortality in end-stage renal disease patients and also increases the risk of allograft rejection and decreases allograft and patient survival post-transplant. Newly developed direct acting antivirals have revolutionized the way HCV is treated. Whether patients are treated before or after kidney transplantation, the cure rates with direct acting antivirals are >90%. Great debate has formed revolving the optimal timing to treat kidney transplant candidates. On the one hand, treatment before transplantation decreases early post-transplant complications related to HCV. On the other, postponing treatment until after transplantation opens the possibility of transplanting a kidney from a HCV positive donor, which is associated with shorter waiting time and improved organ utilization by expanding the organ donor pool. Most patients living in an area where waiting time is reduced by accepting an HCV positive kidney would benefit by the strategy of treatment post-transplantation, but this decision needs to be individualized in a patient-by-patient basis given that there are special circumstances (i.e., severe HCV-related extrahepatic manifestations, availability of live donors, etc.) in which treatment before transplant might be preferred.
Collapse
Affiliation(s)
- Abraham Cohen-Bucay
- Renal Section, Boston University Medical Center, Boston, Massachusetts, USA.,Division of Nephrology and Transplant Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jean M Francis
- Renal Section, Boston University Medical Center, Boston, Massachusetts, USA
| | - Craig E Gordon
- Renal Section, Boston University Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Angeletti A, Cantarelli C, Cravedi P. HCV-Associated Nephropathies in the Era of Direct Acting Antiviral Agents. Front Med (Lausanne) 2019; 6:20. [PMID: 30800660 PMCID: PMC6376251 DOI: 10.3389/fmed.2019.00020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 01/23/2019] [Indexed: 12/11/2022] Open
Abstract
Hepatitis C virus (HCV) infection is a systemic disorder that frequently associates with extrahepatic manifestations, including nephropathies. Cryoglobulinemia is a typical extrahepatic manifestation of HCV infection that often involves kidneys with a histological pattern of membranoproliferative glomerulonephritis. Other, less common renal diseases related to HCV infection include membranous nephropathy, focal segmental glomerulosclerosis, IgA nephropathy, fibrillary and immunotactoid glomerulopathy. Over the last decades, the advent of direct-acting antiviral therapies has revolutionized treatment of HCV infection, dramatically increasing the rates of viral clearance. In patients where antiviral therapy alone fails to induce renal disease remission add-on B-cell depleting agents represent an alternative to counteract the synthesis of pathogenic antibodies. Immunosuppressive therapies, such as steroids, alkylating agents, and plasma exchanges, may still represent an effective option to inhibit immune-complex driven inflammatory response, but the potentially associated increase of HCV replication and worsening of liver disease represent a serious limitation to their use.
Collapse
Affiliation(s)
- Andrea Angeletti
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, Bologna, Italy
| | - Chiara Cantarelli
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Paolo Cravedi
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
7
|
Duerr M, Schrezenmeier EV, Lehner LJ, Bergfeld L, Glander P, Marticorena Garcia SR, Althoff CE, Sack I, Brakemeier S, Eckardt KU, Budde K, Halleck F. A prospective study of daclatasvir and sofosbuvir in chronic HCV-infected kidney transplant recipients. BMC Nephrol 2019; 20:36. [PMID: 30717681 PMCID: PMC6360788 DOI: 10.1186/s12882-019-1218-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Only a few prospective trials exist regarding the use of novel direct-acting antiviral agents (DAAs) in kidney transplant recipients (KTR) with chronic hepatitis C virus (HCV) infection. METHODS This prospective single-center trial evaluated treatment with daclatasvir (DCV) and sofosbuvir (SOF) over 12 weeks in 16 adult chronic HCV infected KTR and eGFR > 30 ml/min/1.73m2. Primary endpoint was sustained virological response 12 weeks after end of therapy (SVR12). Beside baseline liver biopsy, hepatic function and glucose metabolism were regularly assessed. RESULTS Four of 16 study patients had previously failed interferon-based HCV treatment. Liver biopsy showed mostly moderate fibrosis score before therapy with DCV/SOF was initiated at a median of 10.3 years after transplantation. In total, 15 of 16 KTR achieved SVR12. One patient showed early viral relapse because of resistance-associated variants (RAVs) in the HCV NS5A region. Rescue treatment with SOF/velpatasvir/voxilaprevir resulted in SVR12. DAAs treatment led to significant improvement of liver metabolism and glucose tolerance accompanied with no therapy-associated major adverse events and excellent tolerability. CONCLUSIONS Our study demonstrates safety, efficacy and functional benefit of DCV/SOF treatment in KTR with chronic HCV infection. We provide data on rescue strategies for treatment failures due to present RAVs and amelioration of hepatic function and glucose tolerance. TRIAL REGISTRATION Registry name: European Clinical Trials Register; Trial registry number (Eudra-CT): 2014-004551-32 , Registration date: Aug 28th 2015.
Collapse
Affiliation(s)
- Michael Duerr
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Augustenburger Platz, 13353, Berlin, Germany.
| | - Eva V Schrezenmeier
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Augustenburger Platz, 13353, Berlin, Germany
| | - Lukas J Lehner
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Augustenburger Platz, 13353, Berlin, Germany
| | - Léon Bergfeld
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Augustenburger Platz, 13353, Berlin, Germany
| | - Petra Glander
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Augustenburger Platz, 13353, Berlin, Germany
| | | | - Christian E Althoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Brakemeier
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Augustenburger Platz, 13353, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Augustenburger Platz, 13353, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Augustenburger Platz, 13353, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Augustenburger Platz, 13353, Berlin, Germany
| |
Collapse
|
8
|
Race, Risk, and Willingness of End-Stage Renal Disease Patients Without Hepatitis C Virus to Accept an HCV-Infected Kidney Transplant. Transplantation 2019; 102:e163-e170. [PMID: 29346260 DOI: 10.1097/tp.0000000000002099] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite effective antiviral treatment, hundreds of kidneys from deceased donors with hepatitis C virus (HCV) are discarded annually. Little is known about the determinants of willingness to accept HCV-infected kidneys among HCV-negative patients. METHODS At 2 centers, 189 patients undergoing initial or reevaluation for transplant made 12 hypothetical decisions about accepting HCV-infected kidneys in which we systematically varied expected HCV cure rate, allograft quality, and wait time for an uninfected kidney. RESULTS Only 29% of the participants would accept an HCV-infected kidney under all scenarios, whereas 53% accepted some offers and rejected others, and 18% rejected all HCV-infected kidneys. Higher cure rate (odds ratio [OR], 3.49; 95% confidence interval [CI], 2.33-5.24 for 95% vs 75% probability of HCV cure), younger donor (OR, 2.34; 95% CI, 1.91-2.88 for a 20-year-old vs a 60-year-old hypertensive donor), and longer wait for an uninfected kidney (OR, 1.43; 95% CI, 1.22-1.67 for 5 years vs 2 years) were associated with greater willingness to accept an HCV-infected kidney. Black race modified the effect of HCV cure rate, such that willingness to accept a kidney increased less for blacks versus whites as the cure rate improved. Patients older than 60 years and prior kidney recipients showed greater willingness to accept an HCV-infected organ. CONCLUSIONS Most patients will consider an HCV-infected kidney in some situations. Future trials using HCV-infected kidneys may enhance enrollment by targeting older patients and prior transplant recipients, but centers should anticipate that black patients' acceptance of HCV-infected kidneys will be reduced compared with white patients.
Collapse
|
9
|
Wong T, Bloom RD. Management and treatment of the HCV-infected kidney transplant patient. Semin Dial 2018; 32:169-178. [PMID: 30536995 DOI: 10.1111/sdi.12766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The prevalence of hepatitis C virus infection is increased in patients with end stage kidney disease compared to the general population and is an adverse outcome determinant. Direct-acting antiviral therapy for hepatitis C virus is changing the management paradigm of infected kidney transplant candidates and recipients, with potential to reduce patient morbidity and mortality. This review describes the hepatic and nonhepatic manifestations of hepatitis C virus in kidney transplant patients as well as management and treatment strategies to optimize transplant outcomes, highlighting the importance of direct-acting antivirals in this population.
Collapse
Affiliation(s)
- Tiffany Wong
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roy D Bloom
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
10
|
KDIGO 2018 Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease. Kidney Int Suppl (2011) 2018; 8:91-165. [PMID: 30675443 PMCID: PMC6336217 DOI: 10.1016/j.kisu.2018.06.001] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
11
|
Axelrod DA, Schnitzler MA, Alhamad T, Gordon F, Bloom RD, Hess GP, Xiao H, Nazzal M, Segev DL, Dharnidharka VR, Naik AS, Lam NN, Ouseph R, Kasiske BL, Durand CM, Lentine KL. The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes. Am J Transplant 2018; 18:2473-2482. [PMID: 29701909 PMCID: PMC6409105 DOI: 10.1111/ajt.14895] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/14/2018] [Accepted: 04/17/2018] [Indexed: 02/06/2023]
Abstract
Direct-acting antiviral medications (DAAs) have revolutionized care for hepatitis C positive (HCV+) liver (LT) and kidney (KT) transplant recipients. Scientific Registry of Transplant Recipients registry data were integrated with national pharmaceutical claims (2007-2016) to identify HCV treatments before January 2014 (pre-DAA) and after (post-DAA), stratified by donor (D) and recipient (R) serostatus and payer. Pre-DAA, 18% of HCV+ LT recipients were treated within 3 years and without differences by donor serostatus or payer. Post-DAA, only 6% of D-/R+ recipients, 19.8% of D+/R+ recipients with public insurance, and 11.3% with private insurance were treated within 3 years (P < .0001). LT recipients treated for HCV pre-DAA experienced higher rates of graft loss (adjusted hazard ratio [aHR] 1.34 1.852.10 , P < .0001) and death (aHR 1.47 1.681.91 , P < .0001). Post-DAA, HCV treatment was not associated with death (aHR 0.34 0.671.32 , P = .25) or graft failure (aHR 0.32 0.641.26 , P = .20) in D+R+ LT recipients. Treatment increased in D+R+ KT recipients (5.5% pre-DAA vs 12.9% post-DAA), but did not differ by payer status. DAAs reduced the risk of death after D+/R+ KT by 57% (0.19 0.430.95 , P = .04) and graft loss by 46% (0.27 0.541.07 , P = .08). HCV treatment with DAAs appears to improve HCV+ LT and KT outcomes; however, access to these medications appears limited in both LT and KT recipients.
Collapse
Affiliation(s)
- D A Axelrod
- Lahey Hospital & Medical Center, Burlington, MA, USA
| | - M A Schnitzler
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
| | - T Alhamad
- Washington University, St. Louis, MO, USA
| | - F Gordon
- Lahey Hospital & Medical Center, Burlington, MA, USA
| | - R D Bloom
- University of Pennsylvania, Philadelphia, PA, USA
| | - G P Hess
- Symphony Health, Conshohocken, PA, USA
| | - H Xiao
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
| | - M Nazzal
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
| | - D L Segev
- Johns Hopkins University, Baltimore, MD, USA
| | | | - A S Naik
- University of Michigan, Ann Arbor, MI, USA
| | - N N Lam
- University of Alberta, Edmonton, AB, Canada
| | - R Ouseph
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
| | - B L Kasiske
- Hennepin County Medical Center, Minneapolis, MN, USA
| | - C M Durand
- Johns Hopkins University, Baltimore, MD, USA
| | - K L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
| |
Collapse
|
12
|
Salvadori M, Tsalouchos A. Hepatitis C and renal transplantation in era of new antiviral agents. World J Transplant 2018; 8:84-96. [PMID: 30148074 PMCID: PMC6107518 DOI: 10.5500/wjt.v8.i4.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/17/2018] [Accepted: 05/30/2018] [Indexed: 02/05/2023] Open
Abstract
Data from World Health Organization estimates that the hepatitis C virus (HCV) prevalence is 3% and approximately 71 million persons are infected worldwide. HCV infection is particularly frequent among patients affected by renal diseases and among those in dialysis treatment. In addition to produce a higher rate of any cause of death, HCV in renal patients and in renal transplanted patients produce a deterioration of liver disease and is a recognized cause of transplant glomerulopathy, new onset diabetes mellitus and lymphoproliferative disorders. Treatment of HCV infection with interferon alpha and/or ribavirin had a poor efficacy. The treatment was toxic, expensive and with limited efficacy. In the post-transplant period was also cause of severe humoral rejection. In this review we have highlighted the new direct antiviral agents that have revolutionized the treatment of HCV both in the general population and in the renal patients. Patients on dialysis or with low glomerular filtration rate were particularly resistant to the old therapies, while the direct antiviral agents allowed achieving a sustained viral response in 90%-100% of patients with a short period of treatment. This fact to date allows HCV patients to enter the waiting list for transplantation easier than before. These new agents may be also used in renal transplant patients HCV-positive without relevant clinical risks and achieving a sustained viral response in almost all patients. New drug appears in the pipeline with increased profile of efficacy and safety. These drugs are now the object of several phases II, III clinical trials.
Collapse
Affiliation(s)
- Maurizio Salvadori
- Department of Transplantation Renal Unit, Careggi University Hospital, Florence 50139, Italy
| | - Aris Tsalouchos
- Nephrology and Dialysis Unit, Saints Cosmas and Damian Hospital, Pescia 51017, Italy
| |
Collapse
|
13
|
Sawinski D, Forde KA, Wyatt CM. New Treatment Options for Hepatitis C Virus Infection in End-Stage Kidney Disease: To Treat or Not to Treat. Am J Kidney Dis 2018; 72:7-9. [DOI: 10.1053/j.ajkd.2018.01.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/30/2018] [Indexed: 12/26/2022]
|
14
|
La Manna G. HCV and kidney transplant in the era of new direct-acting antiviral agents (DAAs). J Nephrol 2018; 31:185-187. [PMID: 29411309 PMCID: PMC5829130 DOI: 10.1007/s40620-018-0476-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 01/24/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Gaetano La Manna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES)-Nephrology, Dialysis and Transplantation Unit, St. Orsola Hospital, University of Bologna, Via G. Massarenti 9 (Pad. 15), 40138, Bologna, Italy.
| |
Collapse
|
15
|
Gupta G, Kang L, Yu JW, Limkemann AJ, Garcia V, Bandyopadhyay D, Kumar D, Fattah H, Levy M, Cotterell AH, Sharma A, Bhati C, Reichman T, King AL, Sterling R. Long-term outcomes and transmission rates in hepatitis C virus-positive donor to hepatitis C virus-negative kidney transplant recipients: Analysis of United States national data. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.13055] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Gaurav Gupta
- Division of Nephrology; Virginia Commonwealth University; Richmond VA USA
| | - Le Kang
- Department of Biostatistics; Virginia Commonwealth University; Richmond VA USA
| | - Jonathan W. Yu
- Department of Biostatistics; Virginia Commonwealth University; Richmond VA USA
| | | | - Victoria Garcia
- Department of Biostatistics; Virginia Commonwealth University; Richmond VA USA
| | | | - Dhiren Kumar
- Division of Nephrology; Virginia Commonwealth University; Richmond VA USA
| | - Hasan Fattah
- Division of Nephrology; Virginia Commonwealth University; Richmond VA USA
| | - Marlon Levy
- Department of Surgery; Virginia Commonwealth University; Richmond VA USA
| | | | - Amit Sharma
- Department of Surgery; Virginia Commonwealth University; Richmond VA USA
| | - Chandra Bhati
- Department of Surgery; Virginia Commonwealth University; Richmond VA USA
| | - Trevor Reichman
- Department of Surgery; Virginia Commonwealth University; Richmond VA USA
| | - Anne L. King
- Division of Nephrology; Virginia Commonwealth University; Richmond VA USA
| | - Richard Sterling
- Section of Hepatology; Virginia Commonwealth University; Richmond VA USA
| |
Collapse
|
16
|
Use of HCV+ Donors Does Not Affect HCV Clearance With Directly Acting Antiviral Therapy But Shortens the Wait Time to Kidney Transplantation. Transplantation 2017; 101:968-973. [PMID: 27495759 DOI: 10.1097/tp.0000000000001410] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is prevalent in the renal transplant population but direct acting antiviral agents (DAA) provide an effective cure of HCV infection without risk of allograft rejection. METHODS We report our experience treating 43 renal transplant recipients with 4 different DAA regimens. RESULTS One hundred percent achieved a sustained viral response by 12 weeks after therapy, and DAA regimens were well tolerated. Recipients transplanted with a HCV+ donor responded equally well to DAA therapy those transplanted with a kidney from an HCV- donor, but recipients of HCV+ organs experienced significantly shorter wait times to transplantation, 485 days (interquartile range, 228-783) versus 969 days (interquartile range, 452-2008; P = 0.02). CONCLUSIONS On this basis, we advocate for a strategy of early posttransplant HCV eradication to facilitate use of HCV+ organs whenever possible. Additional studies are needed to identify the optimal DAA regimen for kidney transplant recipients, accounting for efficacy, timing relative to transplant, posttransplant clinical outcomes, and cost.
Collapse
|
17
|
Eisenberger U, Guberina H, Willuweit K, Bienholz A, Kribben A, Gerken G, Witzke O, Herzer K. Successful Treatment of Chronic Hepatitis C Virus Infection With Sofosbuvir and Ledipasvir in Renal Transplant Recipients. Transplantation 2017; 101:980-986. [PMID: 27495770 DOI: 10.1097/tp.0000000000001414] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Treatment of chronic hepatitis C virus (HCV) infection after renal allograft transplantation has been an obstacle because of contraindications associated with IFN-based therapies. Direct-acting antiviral agents are highly efficient treatment options that do not require IFN and may not require ribavirin. Therefore, we assessed the efficacy and safety of sofosbuvir and ledipasvir in renal transplant patients with chronic HCV infection. METHODS Fifteen renal allograft recipients with therapy-naive HCV genotype (GT) 1a, 1b, or 4 were treated with the combination of sofosbuvir and ledipasvir without ribavirin for 8 or 12 weeks. Clinical data were retrospectively analyzed for viral kinetics and for renal and liver function parameters. Patients were closely monitored for trough levels of immunosuppressive agents, laboratory values, and potential adverse effects. RESULTS Ten patients (66%) exhibited a rapid virologic response within 4 weeks (HCV GT1a, n = 4; HCV GT1b, n = 6). The other 5 patients exhibited a virologic response within 8 (HCV GT 1b, n = 4) or 12 weeks (HCV GT4, n = 1). One hundred percent of patients exhibited sustained virologic response at week 12 after the end of treatment. Clinical measures of liver function improved substantially for all patients. Adverse events were scarce; renal transplant function and proteinuria remained stable. Importantly, dose adjustments for tacrolimus were necessary for maintaining sufficient trough levels. CONCLUSIONS The described regimen appears to be safe and effective for patients after renal transplant and is a promising treatment regimen for eradicating HCV in this patient population.
Collapse
Affiliation(s)
- Ute Eisenberger
- 1 Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Germany. 2 Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Germany. 3 Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Germany. 4 Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Krisl JC, Doan VP. Chemotherapy and Transplantation: The Role of Immunosuppression in Malignancy and a Review of Antineoplastic Agents in Solid Organ Transplant Recipients. Am J Transplant 2017; 17:1974-1991. [PMID: 28394486 DOI: 10.1111/ajt.14238] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/07/2017] [Accepted: 02/11/2017] [Indexed: 01/25/2023]
Abstract
It is estimated that solid organ transplant recipients have a two- to fourfold greater overall risk of malignancy than the general population. Some of the most common malignancies after transplant include skin cancers and posttransplant lymphoproliferative disorder. In addition to known risk factors such as environmental exposures, genetics, and infection with oncogenic viruses, immunosuppression plays a large role in the development of cancer through the loss of the immunosurveillance process. The purpose of this article is to explain the role of immunosuppression in cancer and to review the classes of chemotherapeutics. The field of anticancer drugs is continually expanding and developing, with limited data on use in transplant recipients. This article aims to provide information on class review, adverse effects, dose adjustments, and drug interactions that are pertinent to the care of transplant recipients.
Collapse
Affiliation(s)
- J C Krisl
- Houston Methodist Hospital, Houston, TX
| | - V P Doan
- The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
19
|
Boyle SM, Lee DH, Wyatt CM. HIV in the dialysis population: Current issues and future directions. Semin Dial 2017; 30:430-437. [PMID: 28608994 DOI: 10.1111/sdi.12615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Antiretroviral therapy has significantly reduced mortality due to HIV infection, but the aging HIV-positive patient population now faces a growing burden of comorbidity. This review describes the changing epidemiology of chronic kidney disease and end-stage renal disease in this population, and highlights recent advances in antiretroviral therapy and kidney transplantation that directly impact the care of patients with HIV infection and end-stage renal disease.
Collapse
Affiliation(s)
- Suzanne M Boyle
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Dong H Lee
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Christina M Wyatt
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
20
|
Suarez Benjumea A, Gonzalez-Corvillo C, Sousa JM, Bernal Blanco G, Suñer Poblet M, Perez Valdivia MA, Gonzalez Roncero FM, Acevedo P, Gentil Govantez MA. Hepatitis C Virus in Kidney Transplant Recipients: A Problem on the Path to Eradication. Transplant Proc 2017; 48:2938-2940. [PMID: 27932111 DOI: 10.1016/j.transproceed.2016.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/18/2016] [Accepted: 09/01/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) still has significant prevalence in kidney transplant (KT) recipients and is related to poor recipient and graft survival. New direct-acting antivirals (DAA) are leading to a radical change in the problem. METHODS We studied HCV prevalence at the time of transplantation and in follow-up patients, the way cases are handled, and the results of DAA. RESULTS A total of 2,001 KT had been performed in our center since 1978. Pre- or post-transplantation HCV serology was present in 1,880 cases and was positive in 13.4%. A total of 1,195 transplant recipients were still being monitored by us, with only 60 (5%) HCV+ and 45 (3.6%) RNA+ cases. Of these 45 HCV+/RNA+, 25 had been or were being treated, 7 were about to begin treatment, 1 was awaiting new DAA treatment owing to low glomerular filtration rate (GFR), 3 were being evaluated, 2 had been excluded owing to high comorbidity, 2 refused to be treated, 2 needed to return to hemodialysis, and 1 was lost to follow-up. Except 1 case where Viekira Pak was used because of low GFR, all cases included sofosbuvir as the main drug associated with either ledipasvir (70%) or daclatasvir (25%). Ribavirin was added as coadjuvant in 35% of cases. Twenty-one patients had completed treatment (84%). Two patients had to interrupt DAA therapy (8%), one because of hepatotoxicity and the other as a result of a liver transplantation. In every case, the graft maintained function and negativization of viral replication occurred. CONCLUSIONS Side effects have been low, anemia related to ribavirin being the main one. Just one case needed to be interrupted at the 7th week of DAA therapy due to hepatotoxicity. It has frequently been necessary to adjust immunosuppression treatment with the use of higher doses of tacrolimus.
Collapse
Affiliation(s)
| | | | - J M Sousa
- Nephrology, Hospital Virgen del Rocio, Sevilla, Spain
| | | | | | | | | | - P Acevedo
- Nephrology, Hospital Virgen del Rocio, Sevilla, Spain
| | | |
Collapse
|
21
|
Bhamidimarri KR, Ladino M, Pedraza F, Guerra G, Mattiazzi A, Chen L, Ciancio G, Kupin W, Martin P, Burke G, Roth D. Transplantation of kidneys from hepatitis C-positive donors into hepatitis C virus-infected recipients followed by early initiation of direct acting antiviral therapy: a single-center retrospective study. Transpl Int 2017; 30:865-873. [PMID: 28332729 DOI: 10.1111/tri.12954] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/24/2017] [Accepted: 03/12/2017] [Indexed: 12/28/2022]
Abstract
The availability of direct acting antiviral agents (DAA) has transformed the treatment of hepatitis C virus (HCV) infection. The current study is a case series that reports the outcomes from a cohort of twenty-five HCV-infected ESRD patients who received a kidney from an anti-HCV-positive deceased organ donor followed by treatment with DAAs in the early post-transplant period. Time to transplantation and the efficacy of DAA therapy as measured by sustained viral response at 12 weeks were assessed. The median waiting time from original date of activation on the United Network Organ Sharing (UNOS) waiting list until transplantation was 427 days; however, the median time from entering the patient into UNetsm for a HCV-positive offer until transplantation was only 58 days. The 25 patients were started on antiviral treatment early post-transplant (median 125 days) and 24 of 25 (96%) achieved a sustained virologic response at 12 weeks. Tacrolimus dose adjustments were required during antiviral treatment in 13 patients to maintain therapeutic levels. Accepting a kidney from an anti-HCV-positive deceased donor shortened the waiting time for HCV-infected kidney transplant candidates. We recommend that kidneys from anti-HCV-positive donors should be considered for transplant into HCV-infected recipients followed by early post-transplant treatment with DAA agents.
Collapse
Affiliation(s)
- Kalyan R Bhamidimarri
- Department of Medicine, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, FL, USA
| | - Marco Ladino
- Department of Medicine, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, FL, USA
| | - Fernando Pedraza
- Department of Medicine, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, FL, USA
| | - Giselle Guerra
- Department of Medicine, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, FL, USA
| | - Adela Mattiazzi
- Department of Medicine, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, FL, USA
| | - Linda Chen
- Department of Surgery, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, FL, USA
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, FL, USA
| | - Warren Kupin
- Department of Medicine, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, FL, USA
| | - Paul Martin
- Department of Medicine, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, FL, USA
| | - George Burke
- Department of Surgery, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, FL, USA
| | - David Roth
- Department of Medicine, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, FL, USA
| |
Collapse
|
22
|
D'Ambrosio R, Degasperi E, Colombo M, Aghemo A. Direct-acting antivirals: the endgame for hepatitis C? Curr Opin Virol 2017; 24:31-37. [PMID: 28419938 DOI: 10.1016/j.coviro.2017.03.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/30/2017] [Indexed: 12/13/2022]
Abstract
Directly-acting antivirals (DAA) have finally allowed all patients to be potentially cured from chronic hepatitis C (HCV) infection. All-oral, Interferon (IFN)-free regimens are based upon the combination of molecules targeting different sites of the HCV replication process. Three classes of DAA exist: protease inhibitors (anti-NS3/4A), RNA-dependent polymerase inhibitors (anti-NS5B) and anti-NS5A inhibitors, which are characterized by different antiviral potency and barrier to resistance and therefore are usually combined in different treatment schedules. Treatment regimens are still largely dependent on HCV genotype and stage of liver disease, with duration ranging between 12 weeks and 24 weeks, while overall treatment efficacy has climbed to nearly 95% in most patient groups, including historically difficult-to-treat categories (HCV genotype 1, advanced liver disease). The elimination of IFN has allowed safe and efficacious treatment of patients formerly contraindicated to antiviral therapy, such as decompensated cirrhosis and solid organ transplant recipients. Availability of potent and safe antiviral drugs combined with improvement of worldwide access to treatment could finally lead to HCV elimination in the next decades.
Collapse
Affiliation(s)
- Roberta D'Ambrosio
- Division of Gastroenterology and Hepatology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Elisabetta Degasperi
- Division of Gastroenterology and Hepatology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Massimo Colombo
- Humanitas Clinical and Research Center, Humanitas Research Hospital, Rozzano, Italy
| | - Alessio Aghemo
- Division of Gastroenterology and Hepatology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
| |
Collapse
|
23
|
Pedraza FE, Ladino Avellaneda MA, Roth D. Treating hepatitis C viral infection in patients with chronic kidney disease: When and how. Clin Liver Dis (Hoboken) 2017; 9:55-59. [PMID: 30992958 PMCID: PMC6467141 DOI: 10.1002/cld.617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 12/27/2016] [Accepted: 01/04/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Fernando E. Pedraza
- University of Miami Miller School of MedicineDivision of Nephrology and Hypertension and the Miami Veterans Administration HospitalMiamiFL
| | - Marco A. Ladino Avellaneda
- University of Miami Miller School of MedicineDivision of Nephrology and Hypertension and the Miami Veterans Administration HospitalMiamiFL
| | - David Roth
- University of Miami Miller School of MedicineDivision of Nephrology and Hypertension and the Miami Veterans Administration HospitalMiamiFL
| |
Collapse
|
24
|
Cheungpasitporn W, Thongprayoon C, Wijarnpreecha K, Sakhuja A, Kittanamongkolchai W, Bruminhent J. Efficacy and safety of direct-acting antivirals for treatment of hepatitis C infected kidney transplant recipients; a meta-analysis. J Nephropharmacol 2017. [DOI: 10.15171/npj.2017.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
|
25
|
Shelton BA, Mehta S, Sawinski D, Reed RD, MacLennan PA, Gustafson S, Segev DL, Locke JE. Increased Mortality and Graft Loss With Kidney Retransplantation Among Human Immunodeficiency Virus (HIV)-Infected Recipients. Am J Transplant 2017; 17:173-179. [PMID: 27305590 PMCID: PMC5159327 DOI: 10.1111/ajt.13922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/13/2016] [Accepted: 06/08/2016] [Indexed: 01/25/2023]
Abstract
Excellent outcomes have been demonstrated in primary human immunodeficiency virus (HIV)-positive (HIV+) kidney transplant recipients, but a subset will lose their graft and seek retransplantation (re-KT). To date, no study has examined outcomes among HIV+ re-KT recipients. We studied risk for death and graft loss among 4149 (22 HIV+ vs. 4127 HIV-negative [HIV-]) adult re-KT recipients reported to the Scientific Registry of Transplant Recipients (SRTR) (2004-2013). Compared to HIV- re-KT recipients, HIV+ re-KT recipients were more commonly African American (63.6% vs. 26.7%, p < 0.001), infected with hepatitis C (31.8% vs. 5.0%, p < 0.001) and had longer median time on dialysis (4.8 years vs. 2.1 years, p = 0.02). There were no significant differences in length of time between the primary and re-KT events by HIV status (1.5 years vs. 1.4 years, p = 0.52). HIV+ re-KT recipients experienced a 3.11-fold increased risk of death (adjusted hazard ratio [aHR]: 3.11, 95% confidence interval [CI]: 1.82-5.34, p < 0.001) and a 1.96-fold increased risk of graft loss (aHR: 1.96, 95% CI: 1.14-3.36, p = 0.01) compared to HIV- re-KT recipients. Re-KT among HIV+ recipients was associated with increased risk for mortality and graft loss. Future research is needed to determine if a survival benefit is achieved with re-KT in this vulnerable population.
Collapse
Affiliation(s)
| | - Shikha Mehta
- University of Alabama at Birmingham Comprehensive Transplant Institute
| | | | - Rhiannon D Reed
- University of Alabama at Birmingham Comprehensive Transplant Institute
| | - Paul A MacLennan
- University of Alabama at Birmingham Comprehensive Transplant Institute
| | - Sally Gustafson
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Dorry L Segev
- Johns Hopkins University Comprehensive Transplant Center
| | - Jayme E Locke
- University of Alabama at Birmingham Comprehensive Transplant Institute,Corresponding Author: Jayme E. Locke, MD, MPH, 701 19 Street South, LHRB 748, Birmingham, AL 35294, 205-934-2131 (phone), 205-934-0320 (fax),
| |
Collapse
|
26
|
Abstract
Soon after the hepatitis C virus (HCV) was identified in 1989, it was recognized that the prevalence of infection in patients with ESRD far exceeded that in the general population. Infection with HCV predisposes to the hepatic complications of cirrhosis and hepatocellular carcinoma. However, important extrahepatic manifestations include immune complex glomerular disease, accelerated progression of CKD, increases in cardiovascular event risk, and lymphoproliferative disorders. Advances in understanding the molecular biology of HCV have ushered in a new era in the treatment of this infection. Second generation direct-acting antiviral agents have revolutionized therapy, with sustained virologic response rates (undetectable viral load 12 weeks after completing therapy) of >90% in most patients. Studies using direct-acting antivirals in patients with CKD and those on dialysis are showing excellent safety and efficacy as well. In this context, it is imperative that nephrologists become familiar with this literature, reviewed here, so that the important decisions, including which patients should be treated and the optimal timing to initiate therapy, are vetted in association with the compounding issues of CKD, ESRD, and kidney transplantation.
Collapse
Affiliation(s)
- Marco Ladino
- Division of Nephrology and Hypertension, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, Florida
| | - Fernando Pedraza
- Division of Nephrology and Hypertension, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, Florida
| | - David Roth
- Division of Nephrology and Hypertension, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, Florida
| |
Collapse
|
27
|
Suarez-Benjumea A, Gonzalez-Corvillo C, Bernal-Blanco G, Pascasio-Acevedo JM, Gonzalez-Roncero F, Perez-Valdivia MA, Suñer-Poblet M, Gentil-Govantes MA. New Antivirals for Hepatitis C Infection Among Infected Kidney Transplant Recipients: A Case Report. Transplant Proc 2016; 47:2672-4. [PMID: 26680070 DOI: 10.1016/j.transproceed.2015.09.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/17/2015] [Indexed: 10/22/2022]
Abstract
The most common hepatopathy in end-stage renal disease is chronic hepatitis C virus (HCV) infection, which decreases allograft and patient survival in kidney transplants. Until last year we did not have treatments free of interferon, which was contraindicated after renal transplantation owing to the risk of allograft rejection. Recently, new drugs have been discovered for interferon-free regimens. These drugs present a cure rate of up to 90% and can be used in transplant recipients. Here we present our 1st 3 cases. In our experience, new antivirals have proven to be effective and safe for the treatment of HCV hepatopathy in kidney transplant recipients and liver-kidney transplantation, thus helping us to prevent complications related to HCV infection in transplant recipients.
Collapse
Affiliation(s)
- A Suarez-Benjumea
- U.G.C Uro-Nephrology, Hospital Virgen del Rocio-Macarena, Sevilla, Spain
| | | | - G Bernal-Blanco
- U.G.C Uro-Nephrology, Hospital Virgen del Rocio-Macarena, Sevilla, Spain
| | | | - F Gonzalez-Roncero
- U.G.C Uro-Nephrology, Hospital Virgen del Rocio-Macarena, Sevilla, Spain
| | - M A Perez-Valdivia
- U.G.C Uro-Nephrology, Hospital Virgen del Rocio-Macarena, Sevilla, Spain
| | - M Suñer-Poblet
- U.G.C Uro-Nephrology, Hospital Virgen del Rocio-Macarena, Sevilla, Spain
| | | |
Collapse
|
28
|
Isnard Bagnis C, Cacoub P. Hepatitis C Therapy in Renal Patients: Who, How, When? Infect Dis Ther 2016; 5:313-27. [PMID: 27388502 PMCID: PMC5019972 DOI: 10.1007/s40121-016-0116-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Indexed: 02/07/2023] Open
Abstract
Renal patients are overexposed to hepatitis C virus (HCV) infection. Hepatitis C virus infection may induce renal disease, i.e., cryoglobulinemic membrano-proliferative glomerulopathy and non-cryoglobulinemic nephropathy. Hepatitis C virus impacts general outcomes in chronic kidney disease, dialysis or transplanted patients. Hepatitis C virus infection is now about to be only part of their medical history thanks to new direct acting antiviral drugs exhibiting as much as over 95% of sustained virological response. All HCV-infected patients potentially can receive the treatment. Control of the virus is associated with better outcomes in all cases, whatever the severity of the hepatic or renal disease. This article focuses on HCV-induced renal diseases, the reciprocal impact of HCV infection on the renal outcome and renal status in liver disease, use of new direct-acting antiviral drugs with dosage adaptations and the most recent safety data.
Collapse
Affiliation(s)
- Corinne Isnard Bagnis
- Department of Nephrology AP-HP, Groupe Hospitalier Pitié Salpêtrière, 75013, Paris, France. .,UPMC Univ Paris 06, Paris, France.
| | - Patrice Cacoub
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), 75005, Paris, France.,INSERM, UMR_S 959, 75013, Paris, France.,Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France.,Sorbonne University, UPMC Univ Paris 06, UMR 7211, Paris, France
| |
Collapse
|
29
|
Handisurya A, Kerscher C, Tura A, Herkner H, Payer BA, Mandorfer M, Werzowa J, Winnicki W, Reiberger T, Kautzky-Willer A, Pacini G, Säemann M, Schmidt A. Conversion from Tacrolimus to Cyclosporine A Improves Glucose Tolerance in HCV-Positive Renal Transplant Recipients. PLoS One 2016; 11:e0145319. [PMID: 26735686 PMCID: PMC4703220 DOI: 10.1371/journal.pone.0145319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/25/2015] [Indexed: 01/04/2023] Open
Abstract
Background Calcineurin-inhibitors and hepatitis C virus (HCV) infection increase the risk of post-transplant diabetes mellitus. Chronic HCV infection promotes insulin resistance rather than beta-cell dysfunction. The objective was to elucidate whether a conversion from tacrolimus to cyclosporine A affects fasting and/or dynamic insulin sensitivity, insulin secretion or all in HCV-positive renal transplant recipients. Methods In this prospective, single-center study 10 HCV-positive renal transplant recipients underwent 2h-75g-oral glucose tolerance tests before and three months after the conversion of immunosuppression from tacrolimus to cyclosporine A. Established oral glucose tolerance test-based parameters of fasting and dynamic insulin sensitivity and insulin secretion were calculated. Data are expressed as median (IQR). Results After conversion, both fasting and challenged glucose levels decreased significantly. This was mainly attributable to a significant amelioration of post-prandial dynamic glucose sensitivity as measured by the oral glucose sensitivity-index OGIS [422.17 (370.82–441.92) vs. 468.80 (414.27–488.57) mL/min/m2, p = 0.005), which also resulted in significant improvements of the disposition index (p = 0.017) and adaptation index (p = 0.017) as markers of overall glucose tolerance and beta-cell function. Fasting insulin sensitivity (p = 0.721), insulinogenic index as marker of first-phase insulin secretion [0.064 (0.032–0.106) vs. 0.083 (0.054–0.144) nmol/mmol, p = 0.093) and hepatic insulin extraction (p = 0.646) remained unaltered. No changes of plasma HCV-RNA levels (p = 0.285) or liver stiffness (hepatic fibrosis and necroinflammation, p = 0.463) were observed after the conversion of immunosuppression. Conclusions HCV-positive renal transplant recipients show significantly improved glucose-stimulated insulin sensitivity and overall glucose tolerance after conversion from tacrolimus to cyclosporine A. Considering the HCV-induced insulin resistance, HCV-positive renal transplant recipients may benefit from a cyclosporine A-based immunosuppressive regimen. Trial Registration ClinicalTrials.gov NCT02108301
Collapse
Affiliation(s)
- Ammon Handisurya
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Corinna Kerscher
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Andrea Tura
- Institute of Neurosciences, CNR, Padova, Italy
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Berit Anna Payer
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Mattias Mandorfer
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Johannes Werzowa
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Winnicki
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | | | - Marcus Säemann
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Alice Schmidt
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
- * E-mail:
| |
Collapse
|