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.) Improvement in renal transplantation in the past 25 years has been the result of better immunosuppression, organ preservation, and patient selection. 1,2 In patients receiving a kidney transplant, chronic liver disease remains a major problem and leads to enhanced morbidity and mortality. 3 In these cases, HBV and HCV infection are the main causes of liver injury. [4][5][6] In transplanted patients, immunosuppressive therapy increases viral replication, and disappearance of anti-HCV antibodies is observed in 20% of cases. [5][6][7][8] Paradoxically, no consensus is available concerning the prognostic influence of HBV and HCV infections on graft and patient survival.Although liver injury progression seems to be greater in transplanted patients than in immunocompetent patients, the influence of HBV on patient and graft survival remains controversial. 4,9-14 These contradictory results may be attributed to the wide heterogeneity of characteristics of patients at the time of transplantation.In kidney transplanted patients, prevalence of HCV infection ranged from 20% to 30%. [15][16][17][18] Now, since the advent of routine HBV vaccination, most hepatic diseases in kidney transplantation are mainly a result of HCV virus infection. 19,20 The most frequent risk facto...

No abstract

African and Middle East geographic origins, HHV-8 infection before and after kidney transplantation, and initial use of polyclonal antilymphocyte sera were independent risk factors for KS. The presence of HHV-8 antibodies before or after transplantation was highly predictive of the emergence of posttransplantation KS and conferred a 28-fold increased risk of KS (odds ratio=28.4; 95% confidence interval: 4.9-279). Detection of HHV-8 DNA within PBMC and KS lesions seems related to tumor burden and evolution.

No abstract