Intermediate-term outcomes of hepatitis C-positive compared with hepatitis C-negative deceased-donor renal allograft recipients

Brown, Kristian L.; El-Amm, Jose M.; Doshi, Mona D.; Singh, Atul Kumar; Morawski, Katherina; Cincotta, Elizabeth; Siddiqui, Firdous; Losanoff, Julian E.; West, Michael O.; Gruber, Scott A.

doi:10.1016/j.amjsurg.2007.12.005

Cited by 11 publications

(7 citation statements)

References 20 publications

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“…Patients who were HIV+, received expanded criteria donor kidneys, or had primary graft failure because of accelerated acute rejection (AR), renal vascular thrombosis, or death in the perioperative period were excluded from analysis. Transplant candidates who were positive for hepatitis C virus (HCV) by quantitative PCR RNA testing underwent liver biopsy, and if cirrhosis was not present, the patient was cleared for renal transplantation (15). Only HCV+ recipients were eligible to receive a kidney from a HCV+ donor.…”

Section: Methodsmentioning

confidence: 99%

Outcome predictors in African‐American deceased‐donor renal allograft recipients

Brown

El-Amm

Doshi

et al. 2009

Clinical Transplantation

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The relative importance of donor and recipient risk factors in predicting outcomes in African-American (AA) renal allograft recipients receiving contemporary immunosuppression, including early steroid withdrawal, has not been previously examined. We assessed the impact of 21 risk factors on five primary outcomes in 132 deceased-donor AA renal allograft recipients transplanted from July 2001 to August 2006 with follow-up 6-67 (mean 35 +/- 17) months by univariate and multivariate analysis. Thymoglobulin or basiliximab was given for induction, and mycophenolate mofetil with either tacrolimus or sirolimus (SRL) +/- prednisone for maintenance. Non-compliance accounted for 26% of graft loss (GL) and 19% of acute rejection (AR) episodes, and was more prevalent in patients who were HCV+ and those on prednisone. Delayed graft function remained a significant predictor of GL, but not via increased AR, and donor ethnicity emerged as an important predictor of patient death. De novo use of SRL resulted in increased AR, and only increased recipient age significantly predicted new-onset diabetes mellitus. Our preliminary results suggest the need for improvements in patient education, pre-transplant psychosocial assessment, and late post-transplant psychosocial support and can be utilized to help guide donor/recipient selection and tailor immunosuppressive management to optimize outcomes in this challenging group of patients.

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Section: Methodsmentioning

confidence: 99%

Outcome predictors in African‐American deceased‐donor renal allograft recipients

Brown

El-Amm

Doshi

et al. 2009

Clinical Transplantation

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“…Finally, given the pronounced pharmacokinetic interactions between the antiretrovirals and calcineurin inhibitors, close monitoring on the part of the transplant center and total compliance on the part of the recipient are essential for a successful outcome, and these factors may also account for differences in the rate of AR in HIVϩ patients at different programs. For example, we have previously demonstrated that HCVϩ renal allograft recipients have similar patient, but decreased graft, survival when compared with their HCVϪ counterparts due primarily to increased graft loss secondary to noncompliance (22).…”

Section: Compared Outcomes In 38mentioning

confidence: 98%

Preliminary Experience With Renal Transplantation in HIV+ Recipients: Low Acute Rejection and Infection Rates

et al. 2008

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Our findings suggest that HIV+ patients on highly active antiretroviral therapy can undergo successful renal transplantation with a low incidence of both AR and AIDS-associated and non-AIDS associated infections, despite associated risk factors for poorer outcome. Our encouraging but preliminary results with this protocol will need to be verified in larger numbers of HIV+ renal allograft recipients with longer follow-up.

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“…For hepatitis C virus (HCV) infection, recipient positivity was not a predictor of acute rejection in the large USRDS analysis by Cole et al . or in multicenter or single‐center studies , but in a single‐center retrospective analysis of 2269 patients over the period 1991–2007 which assessed both recipient and donor serostatus, R+/D‐ status was a significant predictor of acute rejection versus R‐/D‐ (adjusted hazard ratio 1.7, 95% CI 1.2–2.5) . In a multi‐center study from Spain which assessed 4304 patients transplanted during 1990–2002, the subpopulation of 587 HCV‐positive patients exhibited a higher rate of acute rejection than HCV‐negative recipients but included a higher proportion of retransplanted and immunized patients .…”

Section: Recipient Clinical Characteristicsmentioning

confidence: 99%

Pretransplant identification of acute rejection risk following kidney transplantation

et al. 2013

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SummaryLack of an accepted definition for 'high immunological risk' hampers individualization of immunosuppressive therapy after kidney transplantation. For recipientrelated risk factors for acute rejection, the most compelling evidence points to younger age and African American ethnicity. Recipient gender, body mass, previous transplantation, and concomitant infection or disease do not appear to be influential. Deceased donation now has only a minor effect on rejection risk, but older donor age remains a significant predictor. Conventional immunological markers (human leukocyte antigen [HLA] mismatching, pretransplant anti-HLA alloantibodies, and panel reactive antibodies) are being reassessed in light of growing understanding about the role of donor-specific antibodies (DSA). At the time of transplant, delayed graft function is one of the most clear-cut risk factors for acute rejection. Extended cold ischemia time (≥24 h) may also play a contributory role. While it is not yet possible to establish conclusively the relative contribution of different risk factors for acute rejection after kidney transplantation, the available data point to variables that should be taken into account at the time of transplant. Together, these offer a realistic basis for planning an appropriate immunosuppression regimen in individual patients.

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Intermediate-term outcomes of hepatitis C-positive compared with hepatitis C-negative deceased-donor renal allograft recipients

Cited by 11 publications

References 20 publications

Outcome predictors in African‐American deceased‐donor renal allograft recipients

Outcome predictors in African‐American deceased‐donor renal allograft recipients

Preliminary Experience With Renal Transplantation in HIV+ Recipients: Low Acute Rejection and Infection Rates

Pretransplant identification of acute rejection risk following kidney transplantation

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