The prerequisite for an “undetectable” HIV viral load has restricted access to transplantation for HIV-infected kidney recipients. However, HCV-infected recipients, due the historic limitations of HCV therapy in patients with renal disease, are commonly viremic at transplant and have universal access. In order to compare the effect of HIV, HCV and HIV/HCV co-infection on kidney transplant patient and allograft outcomes, we performed a retrospective study of kidney recipients transplanted from January 1996 through December 2013. In multivariable analysis, patient (hazard ratio 0.90, 95% confidence interval 0.66–1.24) and allograft survival (0.60, 40–0.88) in 492 HIV patients did not differ significantly from the 117,791 patient uninfected reference group. This was superior to outcomes in both the 5605 patient HCV group for death (1.44, 1.33–1.56) and graft loss (1.43, 1.31–1.56) as well as the 147 patient HIV/HCV co-infected group for death (2.26, 1.45–3.52) and graft loss (2.59, 1.60–4.19). HIV infection did not adversely affect recipient or allograft survival and was associated with superior outcomes compared to both HCV infection and HIV/HCV co-infection in this population. Thus, pre-transplant viral eradication and/ or immediate post-transplant eradication should be studied as potential strategies to improve post-transplant outcomes in HCV-infected kidney recipients.

Diabetic donor kidneys appear associated with higher mortality risk compared with nondiabetic donor kidneys, but offer greater survival benefit compared with remaining on the waitlist for many candidates. Patients with high risk of mortality on the waitlist at centers with long wait times appear to benefit most from transplantation with diabetic donor kidneys.

Although the transplant and resection populations differ, occult multifocality is common in transplant explants and similar to the 46% early recurrence rate following partial hepatectomy. These data suggest that noncurative resection often results from occult intrahepatic multifocality present at the time of resection rather than a malignant predisposition of the remnant liver with de novo tumorigenesis.

Background While tacrolimus is the basis of most maintenance immunosuppression regimens for kidney transplantation, concerns about toxicity have made alternative agents, such as belatacept, attractive to clinicians. However, limited data exists to directly compare outcomes with belatacept-based regimens to tacrolimus. Methods We performed a propensity score matched cohort study of adult kidney transplant recipients transplanted between May 1, 2001 and December 31, 2015 using national transplant registry data to compare patient and allograft survival in patients discharged from their index hospitalization on belatacept versus tacrolimus-based regimens. Results In the primary analysis, we found that belatacept was not associated with a statistically significant difference in risk of patient death (HR 0.84, 95% CI 0.61-1.15, p=0.28) or allograft loss (HR 0.83, 95% CI 0.62-1.11, p=0.20) despite an increased risk of acute rejection in the first year posttransplant (OR 3.12, 95% CI 2.13-4.57, p<0.001). These findings were confirmed in additional sensitivity analyses that accounted for use of belatacept in combination with tacrolimus, transplant center effects, and differing approaches to matching. Conclusions Belatacept appears to have similar longitudinal risk of mortality and allograft failure compared to tacrolimus-based regimens. These data are encouraging but require confirmation in prospective randomized controlled trials.

BackgroundHepatitis C virus (HCV) infection is common in dialysis patients and renal transplant recipients and has been associated with diminished patient and allograft survival. HCV-positive (HCV+) kidneys have been used in HCV-positive (HCV+) recipients as a means of facilitating transplantation and expanding the organ donor pool; however, the effect of donor HCV serostatus in the modern era is unknown.MethodsUsing national transplant registry data, we created a propensity score–matched cohort of HCV+ recipients who received HCV-positive donor kidneys compared to those transplanted with HCV-negative kidneys.ResultsTransplantation with an HCV+ kidney was associated with an increased risk of death {hazard ratio [HR] 1.43 [95% confidence interval (CI) 1.18–1.76]; P < 0.001} and allograft loss [HR 1.39 (95% CI 1.16–1.67); P < 0.001] compared with their propensity score–matched counterparts. However, HCV+ kidneys were not associated with an increased risk of acute rejection [odds ratio 1.16 (95% CI 0.84–1.61); P = 0.35].ConclusionsWhile use of HCV+ donor kidneys can shorten the wait for renal transplantation and maximize organ utility for all candidates on the waiting list, potential recipients should be counseled about the increased risks associated with HCV+ kidney.