Impact of Biologics for Induction in Kidney Transplant Patients with a Positive Serology for Hepatitis C

Abstract

Introduction: Kidney transplantation is the best therapeutic option for HCV-positive patient with terminal chronic renal failure. However, there is limited and contradictory information on the impact that induction therapy with biological agents may have in this risk group. Aim of the study: Analyze the mid-term efficacy and safety of the induction with biologics (lymphocyte-depleting antibodies or anti-CD25 antibodies) in kidney transplant patients with anti-HCV antibodies positive, in terms of patient survival, graft survival and outcome of liver disease. Patients and methods: Retrospective observational study, based on the analysis of the clinical charts of HCV positive kidney recipients (EIA 1,2,3) at the moment of transplantation (TX) receiving a kidney graft in two Spanish units from March 1990 to March 2007, with follow-up until May 2007. 465 patients who met the inclusion criteria (anti-HCV antibodies positive at the moment of transplantation), and none of the exclusion criteria (HBsAg (+), IFN before Tx, previous or simultaneous transplant of a non-kidney graft), 301 did not receive induction therapy (Group I), 117 were treated with ATG, OKT3 or Timoglobuline ® (Group II), and 47 were treated with anti-CD25 antibodies (Group III). Induction therapy is only applied in patients with a high-immunological risk. Results: The induction with biological agents were not identified as an independent risk factor for the death of the patient (OR = 0, 869, 95% CI 0, 552-1, 369, p = 0, 545) being the 3-years patient survival of 91%, 92% and 93% in the three groups respectively (p = 0. 597). No patient died due to liver disease in groups II and III, and only five did so in group I. The death-censored graft survival to 3 years was similar between groups: 83% group I; 76% Group II; 81% Group III respectively (p = 0. 565). In addition, in the multivariate analysis, induction therapy was not an independent risk factor for graft loss among HCV-positive patients (O = 0. 877, CI 95% 0.646-1.192, p = 0. 403). Also, there were no significant differences in the evolution of ALT post-transplant levels, or in the incidence of postransplant severe clinical liver disease. Conclusion: Our data suggest that induction with biologics in HCV-positive kidney transplant patients with high-immunological risk, is related to a favorable mid-term results with regard to the graft survival, patient survival and without a negative impact on the clinical course of liver disease.