April 01, 2013
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HCV coinfection not predictive of kidney disease in liver transplant recipients with HIV

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Liver transplant recipients with HIV and hepatitis C were not at increased risk for chronic kidney disease compared with those with HIV alone, but coinfection may be linked to more advanced disease, according to recent results.

Researchers evaluated data from 81 patients coinfected with HCV and HIV and 35 with HIV who underwent orthotopic liver transplantation between 2003 and 2010. Chronic kidney disease (CKD) prevalence before transplantation and 1 and 3 years after was determined in each group, with a median follow-up of 3.6 years.

Suspected CKD before transplant (estimated glomerular filtration rate [eGFR] less than 60 mL/min) was observed in 34 patients, including 22 with stage 3 (eGFR of 30-60 mL/min), nine with stage 4 (15-30 mL/min) and three with stage 5 (10-15 mL/min) CKD. Among them, 20 developed stage 3 CKD or greater after transplant.

Half of patients without pre-transplant CKD developed CKD after the procedure, including 11 with stage 4/5 CKD. Cumulative CKD incidence rates within this group were 30% for stage 3 and 1% for stage 4/5 CKD at 1 year and 62% for stage 3 and 8% for stage 4/5 at 3 years. The difference in rates between coinfected and HIV-infected patients was significant at 3 years post-transplant (0% of HIV-infected vs. 12% coinfected; P=.01).

Multivariate analysis indicated that advanced age was associated with post-transplant CKD (HR=1.05 per year; P=.03), while a higher CD4 count following transplant reduced CKD risk (HR=0.90 per 50 cells/mcL; P=.01). Coinfection with HCV was associated with developing stage 4 or 5 CKD after transplant (HR=10.8; P=.03), although analysis was limited by a small number of cases.

“The results … reveal that CKD is prevalent both pre- and post-transplant in HIV-positive liver transplant recipients,” the researchers wrote. “The event numbers were small for a robust analysis, but [raise] the possibility of an association that could be confirmed with a larger sample size and/or longer duration of follow-up, as our multivariate analysis did suggest an association between HCV coinfection and stage 4/5 post-transplant CKD.”