Hepatitis C Virus Infection and Outcome of Renal Transplantation (original) (raw)
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Impact of Hepatitis C Virus on Renal Transplantation: Association With Poor Survival
Transplantation Proceedings, 2006
Data concerning the effect of hepatitis C virus (HCV) infection on the long-term outcome of patient and allograft survival are conflicting. We performed a retrospective study including all renal transplant recipients who underwent the procedure at our center between July 1983 and December 2004. We compared HCV-positive (n ϭ 155) versus HCV-negative (n ϭ 1044) recipients for the prevalence of anti-HCV, patient/donor characteristics, and graft/patient survival. The prevalence of HCV-positive patients was 12%. The anti-HCV positive recipients displayed a longer time on dialysis (P Ͻ .001), more blood transfusions prior to transplant (P Ͻ .001), and a higher number of previous transplants (P Ͻ .001). There were no differences in the incidence of acute rejection between the two groups. Patient (P ϭ .006) and graft survival (P ϭ .012) were significantly lower in the HCV-positive than the HCV-negative group. Graft survival censored for patient death with a functioning kidney did not differ significantly between HCV-positive and HCV-negative recipients (P ϭ .083). Death from infectious causes was significantly higher among the HCV-positive group (P ϭ .014). We concluded that HCV infection had a significant detrimental impact on patient and renal allograft prognosis. Death from infectious causes was significantly more frequent among HCV-positive than the non-HCV population.
The impact of hepatitis C virus infection on long-term outcome in renal transplant patients
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2011
The aim of this study was to determine the effect of hepatitis C virus infection on patient and graft survival and liver function in renal transplant patients. 1811 renal transplant patients were included in this study. One hundred renal transplant patients (5.5%) were anti-hepatitis C virus-positive. We evaluated demographic, clinical, biochemical, and serological data of patients and compared patient and graft survivals between hepatitis C virus-positive and -negative renal transplant patients. The median follow-up period was 35.7 months. One hundred (5.5%) patients were anti-hepatitis C virus-positive. There were no differences between anti-hepatitis C virus-positive and -negative renal transplant patients regarding age, etiology of renal disease, number of pre-transplant blood transfusions, and hepatitis B virus coinfection rate. Rate of graft loss in anti-hepatitis C virus-positive renal transplant patients was significantly higher than in anti-hepatitis C virus-negative patien...
Impact of hepatitis B and C virus on kidney transplantation outcome
Hepatology, 1999
The impact of hepatitis B (HBV) and C (HCV) on patient survival after kidney transplantation is controversial. The aims of this study were (1) to assess the independent prognostic values of HBsAg and anti-HCV in a large renal transplant population, (2) to compare infected patients with noninfected patients matched for factors possibly associated with graft and patient survival, and (3) to assess the prognostic value of biopsy-proven cirrhosis. Eight hundred thirty-four transplanted patients were included: 128 with positive HBsAg (group I), 216 with positive anti-HCV (group II), and 490 without serological markers of HBV and HCV (group III). Fifteen percent and 29% of patients were HBsAg-positive and anti-HCV-positive, respectively. Tenyear survivals of group I (55 ؎ 6%) and group II (65 ؎ 5%) were significantly lower than survival of group III (80 ؎ 3%, P F .001). At 10 years, among overall patients with HCV screening (n ؍ 834), four variables had independent prognostic values in patient survival: age at transplantation (P F .0001), year of transplantation (P ؍ .02), biopsyproven cirrhosis (P ؍ .03), and presence of HCV antibodies (P ؍ .02). In the case control study, comparison of infected patients with their matched control patients showed that age at transplantation (P F .05), HBsAg (P ؍ .005), and anti-HCV (P ؍ .005) were independent prognostic factors. HCV, biopsy-proven cirrhosis, and age are independent prognostic factors of 10-year survival in patients with kidney grafts. The case-control study showed that anti-HCV and HBsAg were independently associated with patient and graft survivals. In infected patients, a routine liver histological analysis would improve selection of patients for renal transplantation.(HEPATOLOGY 1999;29:257-263.)
Impact of hepatitis C virus infection in renal transplant recipients
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
The impact of hepatitis C virus (HCV) infection on the success of renal transplant is controversial. We assessed the effect of HCV infection on graft and patient survival in renal allograft recipients. We retrospectively analyzed medical records of renal allograft recipients who were transplanted between June 1990 and March 2004. Patients were divided into those positive and negative for anti-HCV antibody. Graft and patient survival were compared between the groups. Of 126 patients studied (median age 34.5 years, range, 16-60; 111 men), 35 were positive for anti-HCV antibody. In seven patients, the antibodies were detected for the first time after renal transplant. Mean patient and graft survival duration in the anti-HCV negative group was longer (55 [SD 2] months [95% CI, 51-58]) than in the anti-HCV positive group (50 [SD 4] months [95% CI, 43-58]) (p< 0.05). Twenty-two patients died - 8 (22.8%) in the anti-HCV positive group and 14 (15.3%) in the negative group. In the anti-HC...
Impact of Hepatitis C Virus Infection on Patient and Graft Survival in Kidney Transplantation
Transplantation Proceedings, 2006
Hepatitis C virus (HCV) infection is the main cause of chronic liver disease after renal transplantation, which represents a risk factor for graft loss and patient death. Hepatitis C (ϩ) kidney transplant candidates who remain on the waiting list show a greater risk of mortality than those who are transplanted, a risk that escalates with time. The aim of this study was to examine the impact of HCV infection on patient and allograft survival in our transplant population. Among 90 renal transplant patients transplanted between 1991 and 2002 who were retrospectively analyzed, 45 were HCV-positive and 45 HCV-negative by serology. All positive patients had shown positive HCV antibody and/or positive HCV RNA. The mean ages of the patients were 36.2 Ϯ 9 years among the HCV (ϩ) and 38 Ϯ 10 years among the HCV (Ϫ) patients (P ϭ .31). Eighteen HCV (ϩ) patients and 14 HCV (Ϫ) patients received their grafts from deceased donors. The immunosuppressive protocols were similar in both groups. The number of acute rejection episodes were 13 (30%) in HCV (ϩ) and 6 (13%) in the HCV (Ϫ) group (P ϭ .006). Diabetes mellitus developed in 10 (23%) HCV (ϩ) and 7 (16%) HCV (Ϫ) patients (P ϭ .04). Cytomegalovirus disease occurred in 5 (16%) HCV (ϩ) and 2 (6%) HCV (Ϫ) patients (P ϭ .32). The mean serum creatinine was 1.85 Ϯ 1.1 mg/dL in HCV (ϩ) and 1.8 Ϯ 1 mg/dL in HCV (Ϫ) group (P ϭ .82). The mean graft survivals were 97.1 Ϯ 52 months in the HCV (ϩ) and 81.1 Ϯ 37 months in the HCV (Ϫ) group (P ϭ .04). Seven HCV (ϩ) patients (16%) and three HCV (Ϫ) patients (6%) lost their grafts (P ϭ .04). Advanced cirrhosis developed in three HCV (ϩ) patients (6%). One patient died in the HCV (ϩ) group. Patient survivals were 98% in the HCV (ϩ) and 100% in the HCV (Ϫ) cohorts. In this study, the rate of graft loss was higher in HCV (ϩ) patients, whereas the patient survival was similar.
Transplantation Proceedings, 2007
Previous studies had shown that HBV and HCV infections lead to increased morbidity and mortality after kidney transplantation when compared with the nonhepatitis group. However, few studies have compared the impact among a population with a high prevalence of HBV and HCV infections. We studied the outcomes of 346 recipients including 23 HBsAg (ϩ) patients (6.6%; group 1), 22 patients with anti-HCVϩ (6.3%, group 2), and 301 nonhepatitis patients (group 3) in a single center during a 6-year period. No patient had evidence of precirrhosis or cirrhosis before transplant. The primary end point was graft and patient survival rates. Secondary end point was the rate of progression of chronic allograft, nephropathy. The median follow-up time was 3.7 (0.5-6.8) years.
Long-Term Impact in Hepatitis C Virus Infection in Post Renal Transplantation
Open Journal of Organ Transplant Surgery, 2012
Purpose: The authors have evaluated the impact of the kidney transplantation associated with chronic hepatitis C virus (HCV) infection, analyzing the complications, patients and graft survival. Methods: Retrospective study with 40 kidney transplant recipients with HCV infection and 40 kidney transplant recipients without HCV infection in the same post transplantation period. Results: The average follow-up after transplantation was 12.3 ± 4.5 years in patients with HCV infection and 12.5 ± 2.9 years in patients without HCV infection (p = 0.49). There was no statistical difference related to age and gender of the recipient nor donor age and type. The current renal function in patients with HCV infection was 47.3 ± 24.9 mL/min and 54.9 ± 27.2 mL/min in the HCV negative group (p = 0.54). The incidence of graft and patient survival was similar in both groups. The main cause of death in both groups was bacterial infection (10% in patients with HCV infection and 12.5% in HCV negative patients (p = 0.63). The most common complication in the two groups were acute allograft rejection and bacterial infection. The incidence of diabetes mellitus did not differ statistically in both groups. Abnormal liver enzymes levels and cirrhosis were observed only in patients with HCV infection. Conclusion: HCV infection did not impact patient or graft survival and post-transplant complications were similar in both groups during a mean follow-up period of 12 years.
Renal transplantation in patients with hepatitis C virus antibody. A long national experience
Clinical Kidney Journal, 2010
Background. Renal transplantation is the best therapy for patients with hepatitis C virus (HCV) infection with endstage renal disease. Patient and graft survival are lower in the long term compared with HCV-negative patients. The current study evaluated the results of renal transplantation in Spain in a long period (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002), focusing on graft failure. Methods. Data on the Spanish Chronic Allograft Nephropathy Study Group including 4304 renal transplant recipients, 587 of them with HCV antibody, were used to estimate graft and patient survival at 4 years with multivariate Cox models. Results. Among recipients alive with graft function 1year post-transplant, the 4-year graft survival was 92.8% in the whole group; this was significantly better in HCV-negative vs HCV-positive patients (94.4% vs 89.5%, P < 0.005). Notably, HCV patients showed more acute rejection, a higher degree of proteinuria accompanied by a diminution of renal function, more graft biopsies and lesions of de novo glomerulonephritis and transplant glomerulopathy. Serum creatinine and proteinuria at 1 year, acute rejection, HCV positivity and systolic blood pressure were independent risk factors for graft loss. Patient survival was 96.3% in the whole group, showing a significant difference between HCV-negative vs HCV-positive patients (96.6% vs 94.5%, P < 0.05). Serum creatinine and diastolic blood pressure at 1 year, HCV positivity and recipient age were independent risk factors for patient death. Conclusions. Renal transplantation is an effective therapy for HCV-positive patients with good survival but inferior than results obtained in HCV-negative patients in the short term. Notably, HCV-associated renal damage appears early with proteinuria, elevated serum creatinine showing chronic allograft nephropathy, transplant glomerulopathy and, less frequently, HCV-associated de novo glomerulonephritis. We suggest that HCV infection should be recognized as a true risk factor for graft failure, and preventive measures could include pre-transplant therapy with interferon.
Clinical Course of Hepatitis C Virus Infection in Renal Transplant Recipients
Transplantation Proceedings, 2007
Patients with end-stage renal disease are at high risk for exposure to hepatitis C virus (HCV) infection. Although both viral replication and liver disease progression are accelerated after renal transplantation, the long-term impact of chronic HCV infection is unclear. Our aim was to analyze the course of HCV infection in renal transplant recipients and the effects of HCV reactivation on patient and graft survival. Methods. We retrospectively examined the 21-year (1985-2006) data of 1274 renal transplant recipients, 43 of whom were anti-HCV positive at the time of transplantation. Results. The mean posttransplant follow-up of 43 patients was 62.0 Ϯ 7.3 months. At the time of transplantation, HCV RNA was positive in 11 (25.6%) patients and negative in 32 (74.4%) patients. HCV reactivation was seen in 19 (45.2%) patients at a mean time of 20.8 Ϯ 5.7 months. In 31 (72%) patients, acute rejection occured, whereas graft loss occured in 10 (23%) patients. Three (7%) patients died. Among 43 patients, 22 (51.2%) were treated with interferon before transplantation. There was a statistically significant association between pretransplant interferon therapy and pretransplant HCVRNA level (P ϭ .024), but no significant association of HCV reactivation and graft rejection, mortality, or kidney survival. Conclusion. HCV reactivation occurred in nearly half of the renal transplant recipients, mostly in the second year. Patient survival and graft survival were not affected by HCV reactivation. Anti-HCV positivity should not preclude chronic renal failure patients from renal transplantation.