Kidney transplant: HCV, HBV control improves survival

Takeaway

• Successful antiviral therapy is essential for improving long-term patient and graft survival among HCV+ kidney transplant recipients.

Why this matters

• Widespread use of nucleos(t)ide analogs has normalized prognosis in HBV+ recipients.
• HCV direct-acting antiviral (DAA) regimens should be systematically proposed before/after transplant.

Study design

• French CRISTAL database study involving 31,433 kidney transplant recipients; 1060 were HCV+, 575 were HBV+, and 29,798 had no viral hepatitis (control patients).
• Funding: Hospital-Based Clinical Research Program, ANRS.

Key results

• 10-year survival was lower in HCV+ patients (71.3%) vs HBV+ patients (81.2%; P=.0004) and control patients (82.7%; P<.0001).
• 10-year graft survival was lower in HCV+ patients (50.6%) vs HBV+ patients (62.3%; P<.0001) and control patients (64.7%; P<.0001).
• Among noncirrhotic patients, absence of viral replication was tied to higher 10-year survival (HR=2.5; 95% CI, 1.3-4.9) and graft survival (HR=1.69; 95% CI, 1.1-2.6).
• A random analysis of patient data (HBV, n=184; HCV, n=504) showed virologic suppression in 94.0% of HBV cases and 35.0% of HCV cases.
• In matched case-control analysis:
  • Detectable HCV RNA predicted poorer 10-year survival (HR=1.61; P=.004) and graft survival (HR=1.31; P=.01).
  • Undetectable HCV RNA yielded higher 10-year survival (HR=0.50; P=.04) and similar 10-year graft survival (P=.30).

Limitations

• Antiviral efficacy not captured.
• Conducted prior to DAA era (1993-2010).