Excessive immunosuppression as a potential cause of poor survival in simultaneous liver/kidney transplantation for hepatitis C

Taizo Hibi, Seigo Nishida, Junichiro Sageshima, David M. Levi, Phillip Ruiz, David Roth, Paul Martin, Koji Okabayashi, George W. Burke, Gaetano Ciancio, Andreas G. Tzakis

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)606-616
Number of pages11
JournalTransplant International
Volume27
Issue number6
DOIs
Publication statusPublished - 2014

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Hepatitis C
Liver Transplantation
Kidney Transplantation
Immunosuppression
Graft Survival
Liver
Hepacivirus
Sepsis

Keywords

  • antiviral treatment
  • graft survival
  • hepatitis C
  • induction immunosuppression
  • patient survival
  • simultaneous liver/kidney transplantation

ASJC Scopus subject areas

  • Transplantation
  • Medicine(all)

Cite this

Excessive immunosuppression as a potential cause of poor survival in simultaneous liver/kidney transplantation for hepatitis C. / 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.

In: Transplant International, Vol. 27, No. 6, 2014, p. 606-616.

Research output: Contribution to journalArticle

Hibi, T, Nishida, S, Sageshima, J, Levi, DM, Ruiz, P, Roth, D, Martin, P, Okabayashi, K, Burke, GW, Ciancio, G & Tzakis, AG 2014, 'Excessive immunosuppression as a potential cause of poor survival in simultaneous liver/kidney transplantation for hepatitis C', Transplant International, vol. 27, no. 6, pp. 606-616. https://doi.org/10.1111/tri.12303
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. / Excessive immunosuppression as a potential cause of poor survival in simultaneous liver/kidney transplantation for hepatitis C. In: Transplant International. 2014 ; Vol. 27, No. 6. pp. 606-616.
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AU - Ruiz, Phillip

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