Kidney transplant from HCV viremic donors to HCV-negative recipients and risk for de novo donor specific antibodies and acute rejection.

Autor: Daloul R; Division of Nephrology, Department of Internal Medicine, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, USA., Sureshkumar K; Division of Nephrology, Department of Internal Medicine, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, USA., Schnelle K; Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA., Von Stein L; Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA., Logan A; Division of Transplantation, Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA., Pesavento T; Division of Nephrology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2023 Feb; Vol. 37 (2), pp. e14895. Date of Electronic Publication: 2023 Jan 11.
DOI: 10.1111/ctr.14895
Abstrakt: Background: Kidney transplantation from HCV-viremic donors into uninfected recipients is associated with excellent short-term outcomes. However, concerns regarding an increased risk for the development of de novo donor specific antibodies (DSA) and acute rejection have been raised in single center reports.
Methods: A retrospective study of HCV-negative kidney-only transplant recipients between 2018 and 2020. Patients were grouped based on the donor HCV status into group 1; HCV-viremic donors, and group 2; HCV-negative donors. Inverse probability of treatment weighting (IPTW), with weights derived from the propensity score, were used to estimate the effect of donors' HCV-viremia on the recipients. The primary objective was to compare the 1-year incidence of de novo DSA. Secondary outcomes included group comparison of the incidence of biopsy proven acute rejection (BPAR), 1-year patient and allograft survival, and 1-year renal allograft function.
Results: A total of 71 patients were included in the HCV NAT+ group, and 440 in the HCV- negative group. One-year incidence of de novo DSA was higher in the HCV NAT+ group in the IPTW weighted analysis (19% vs. 9%, p = .02). In the unweighted analysis, BPAR occurred in 7% of recipients in the HCV NAT+ group, compared to 3% in the control group (p = .06). However, due to the low event rate in the in the IPTW weighted groups, a statistical significance test could not be performed. Average estimated GFR was higher in the HCV-viremic group at 3 months (61 vs. 53 ml/min/1.73 m 2 p = .002), but comparable at 6 (59 vs. 56 ml/min/1.73 m 2 , p = .31) and 12 months (60 vs. 55 ml/min/1.73 m 2 , p = .07). Patient and allograft survival were comparable between the two groups.
Conclusion: Kidney transplant from HCV-viremic donors was associated with an increased risk for the development of post-transplant de novo DSA in the first year after transplantation, but no difference in patient and graft survival.
(© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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