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- Title
Excessive immunosuppression as a potential cause of poor survival in simultaneous liver/kidney transplantation for hepatitis C.
- Authors
Hibi, Taizo; Nishida, Seigo; Sageshima, Junichiro; Levi, David M.; Ruiz, Phillip; Roth, David; Martin, Paul; Okabayashi, Koji; Burke, George W.; Ciancio, Gaetano; Tzakis, Andreas G.
- Abstract
Appropriate recipient selection of simultaneous liver/kidney transplantation ( SLKT) remains controversial. In particular, data on liver graft survival in hepatitis C virus-infected ( HCV+) SLKT recipients are lacking. We conducted a single-center, retrospective study of HCV+ SLKT recipients ( N = 25) in comparison with HCV− SLKT ( N = 26) and HCV+ liver transplantation alone ( LTA, N = 296). Despite backgrounds of HCV+ and HCV− SLKT being similar, HCV+ SLKT demonstrated significantly impaired 5-year liver graft survival of 35% ( HCV− SLKT, 79%, P = 0.004). Compared with HCV+ LTA, induction immunosuppression was more frequently used in HCV+ SLKT. Five-year liver graft survival rate for HCV+ SLKT was significantly lower than that for LTA (35% vs. 74%, respectively, P < 0.001). Adjusted hazard ratio of liver graft loss in HCV+ SLKT was 4.9 (95% confidence interval 2.0-12.1, P = 0.001). HCV+ SLKT recipients were more likely to succumb to recurrent HCV and sepsis compared with LTA (32% vs. 8.8%, P < 0.001 and 24% vs. 8.8%, P = 0.030, respectively). Ten HCV+ SLKT recipients underwent anti- HCV therapy for recurrent HCV; only 1 achieved sustained virological response. HCV+ SLKT is associated with significantly decreased long-term prognosis compared with HCV− SLKT and HCV+ LTA.
- Subjects
LIVER transplantation; KIDNEY transplantation; IMMUNOSUPPRESSION; HEPATITIS C; CONFIDENCE intervals; TACROLIMUS; PATIENTS
- Publication
Transplant International, 2014, Vol 27, Issue 6, p606
- ISSN
0934-0874
- Publication type
Article
- DOI
10.1111/tri.12303