Clinical outcomes in HIV+/HCV+ coinfected kidney transplant recipients in the pre- and post-direct acting antiviral (DAA) therapy eras: 10-year single center experience.

BACKGROUND: Previous studies have demonstrated inferior patient and graft survival following kidney transplant (KT) in HIV+/HCV+ coinfected patients compared to HIV+/HCV- recipients. However, these studies were conducted prior to the availability of direct acting antiviral (DAA) agents and data in the modern era is lacking.

METHODS: Single center retrospective study of HIV+/HCV+ coinfected KT recipients (2007-2017). Outcomes were assessed for the pre-DAA and post-DAA (i.e., after December 2013) eras including 1-year patient survival, death-censored graft survival, and acute rejection; and serious infections (defined as infections requiring admission to the intensive care unit during initial transplant hospitalization or re-admission to the hospital after discharge) within the first six months post-transplant.

RESULTS: A total of 13 consecutive HIV+/HCV+ recipients were identified. Median time of posttransplant follow up was 722 days. Seven patients were transplanted in the DAA era; 5 of them had anti-HCV Ab+ donors, with 2 donors being HCV NAT positive; all received DAA therapy, 6 of them post-transplant (median time from KT to DAA: 83 days; IQR, 54 - 300). All the patients in the pre-DAA era were on a protease inhibitor-containing ART regimen. 1-year patient and death-censored graft survival were 83% and 67%, respectively, for the patients transplanted in the pre-DAA era, and 100% for both outcomes in the subgroup of patients transplanted in the post-DAA era (p>0.05). Compared to patients in the post-DAA era, those in the pre-DAA era had higher incidence of serious infections (0 vs. 67%; p=0.02). Acute rejection exclusively occurred in the pre-DAA group (n=1; 17%).

CONCLUSIONS: Outcomes of HIV+/HCV+ KT recipients, including HIV-/HCV+ to HIV+/HCV+ transplants, in the DAA era were excellent in this small cohort. Larger studies are needed. This article is protected by copyright. All rights reserved.