Kidney transplantation is a well-established treatment option for ESRD patients with Hepatitis C virus (HCV). However, the optimal induction regimen for this population is uncertain, mainly because a stronger immunosuppression may increase HCV viral load and eventually hasten the progression to liver fibrosis.

Methods: Using SRTR, we compared patient/graft survival, acute rejection in the 1 year post-transplant, and delayed graft function (DGF) in 10,617 HCV+ recipients between 1999-2014 by induction regimen. We used shared frailty Cox models and mixed-effects logistic regressions to adjust for the differences among transplant centers.

Results: Factors associated with use of depleting agents were recipient age<40, recipient African American race, PRA>80, longer time on dialysis, and living donor. Regimen choice was also largely explained by center-level variations (ICC=0.41). The hazard of death was significantly lower among those who received anti-thymocyte globulin (ATG) than the no induction group (aHR=_0.800.88_0.97). Alemtuzumab (ALM) group was also at a slightly lower hazard of death, but the difference was not statistically significant (aHR=_0.680.83_1.02). IL-2 receptor antagonist (IL2) recipients were at a similar hazard of death compared with no induction (aHR=_0.921.00_1.09). The hazard of graft loss was higher in the ALM group (aHR=_1.021.30_1.65) but not in the ATG or IL2 groups compared with the no induction group (aHRs=_0.951.07_1.21 and _0.971.09_1.23; Table 1). Acute rejection and DGF were generally similar between the groups (Table 2).

Conclusion: Despite the concerns on the possible adverse effect of immunosuppression on HCV management, our results suggest that ATG is an appropriate induction protocol for HCV+ recipients.

CITATION INFORMATION: Bae S, Durand C, Kucirka L, Massie A, Segev D. Induction Immunosuppression and Post-Transplant Outcomes in Kidney Recipients with Hepatitis C Virus. Am J Transplant. 2016;16 (suppl 3).

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