Hepatitis C virus (HCV) positive kidney transplant recipients face a significant risk of acute rejection (AR), graft loss, new onset diabetes mellitus (NODM), and mortality after transplantation. Some of these risks may be magnified by the use of corticosteroids and/or induction therapy. Historically, our center noted AR rates of approximately 40% at one-year in HCV(+) recipients on a triple-drug immunosuppression regimen.

Methods: We reviewed 31 HCV(+) and 603 HCV(-) kidney transplant recipients receiving rATG induction, tacrolimus, mycophenolate, and a 5 day rapid steroid taper. Groups were compared for demographic and transplant characteristics, and outcomes including AR, patient and graft survival.

Results: Patient demographics were similar between groups, except for higher predominance of males in the HCV(+) group. Median follow-up was 4.5 years in all pts. Actuarial pt survival was similar between groups (P=0.3) (figure 1A), while death-censored graft survival was poorer in HCV(+) pts (72% vs. 93% at 3 yrs; P=0.003) (figure 1B). AR occurred more frequently in the HCV(+) group (20% vs. 6% at 1 yr (P=0.009)) (figure 1C).

Causes of graft loss in the HCV(+) pts included transplant glomerulopathy (n=2), AR, non-compliance, technical complications after IR procedure, and BK virus nephropathy; 5 of the 6 pts had previously experienced AR. Five pts in the HCV(+) group were treated for opportunistic infection (viral or bacterial). Twenty of the HCV(+) pts have serial HCV viral loads before and after transplant; 7 were stable, 7 increased > 1 log, and 6 pts had a negative viral load pre-transplant and remained negative.

Conclusion: Steroid-sparing immunosuppression regimens and induction therapy benefit HCV(+) kidney transplant recipients by reducing the incidence of early AR compared to HCV(+) pts traditionally receiving a triple drug regimen, although the risk is higher than in HCV(-) recipients. With intermediate follow-up, induction therapy with rATG does not appear to have detrimental effects on patient morbidity; however, close follow-up is needed to assess long-term risk.

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