Effect of Chronic Viral Hepatitis on Graft Survival in Saudi Renal Transplant Patients

Abstract

Background: In Saudi Arabia the prevalence of hepatitis C among hemodialysis patients is very high ranging from 60 to 80%. A large number of these dialysis patients go for renal transplant, resulting into a higher prevalence of hepatitis C virus (HCV) infection in renal transplant patients. Yet no current systematic report is available on the influence of hepatitis C status on patient and graft survival. The present study was therefore undertaken to address this objective. Methods: Retrospective analysis of data of 448 renal transplantation subjects was undertaken. The mean follow-up period was 5.85 ± 2.7 (median 5.3) years. The factors associated with renal graft survival were reviewed and these include: age, sex, and type of donor, immunosuppressive medication, episodes of infection, blood pressure, serum creatinine, and status of hepatitis. The primary end-points were renal graft function and patient survival. Logistic regression, COX regression analysis, and Kaplan-Meier survival estimates were used to evaluate the influence of hepatitis C on the above parameters. Results: Among 448 recipients of first kidney transplant patients, 286 (63.8%) were positive for HCV infection. In the HCV-positive group, 204 (71.32%) were males. Kaplan-Meier survival analysis showed a significantly better graft survival for HCV-negative patients than HCV-positive patients (p < 0.001; log-rank test). Logistic regression analysis and COX regression analysis have shown different grades of graft dysfunction were present in HCV-positive patients after adjustment for covariates: age, sex, blood pressure, type of donor, and immunosuppressive medication; the presence of HCV was a major predictor of bad outcome and significantly influenced graft survival (odds ratio = 4.37; 95% Cl = 1.81–4.77). Significant deterioration of liver function was noted in HCV-positive patients at the last follow-up, taking ALT as a marker (ALT level 80.6 ± 5.8 U/l at the last follow-up versus 49.5 ± 32 U/l at baseline p ≤ 0.0001). Sixteen patients had a chronic active course and 1 patient developed biopsy-proven liver cirrhosis and portal hypertension. A serious and significantly greater incidence of fatal chest infections was seen in HCV-positive patients. Although mortality was greater in HCV-positive versus HCV-negative patients (20 vs. 7), the difference did not attain statistical significance (p = 0.23) and none of the patients died as a result of hepatic failure. Conclusion: The presence of HCV infection greatly influenced graft survival in renal transplant patients and a higher proportion of infected patients had renal and hepatic dysfunction. A significant increase in fatal chest infections was noted in HCV-positive patients. Overall mortality was higher in HCV-positive patients, but it was not statistically significant. All measures should be taken to prevent HCV transmission in the dialysis population. Renal transplant recipients with HCV infection need close monitoring for both graft and liver function.

Epidemiological aspects of hepatitis C virus infection among renal transplant recipients in Central Brazil

“…The prevalence of HCV infection of 16.1% found in these patients in GO is almost 12 times greater than that observed among local blood donors (1.4%) (Martins et al 1994). Nevertheless, relative to other Brazilian renal transplant recipient populations, this prevalence is lower than those reported in the cities of Porto Alegre (33%) (Corrêa et al 2003) and Campinas (54%) (Giordano et al 2003); it was, however, in accordance with those carried out in other countries, where rates have been found to range from 7.2% to 63.8% (Fehr et al 2003, Mitwalli et al 2006). In addition, the prevalence among RTP we determined is similar to that reported for hemodialysis patients in GO (16.4%) ).…”

“…These genotypes have distinct geographical distributions. Furthermore, the genotyping of HCV isolates is a useful tool for establishing the source of outbreaks in hemodialysis centers and other nosocomial settings (Zein 2000, Simmonds et al 2005 The prevalence of HCV infection has been reported to range from 7.2% among renal transplant recipients (RTP) in Switzerland to 63.8% in Saudi Arabia (Mitwalli et al 2006, Fehr et al 2003. In Brazil, a continental country, epidemiological data concerning HCV infection in renal transplant patients are still rare (Corrêa et al 2003, Giordano et al 2003, and little is known about the genetic diversity of HCV isolates in these patients (Giordano et al 2003, Perez et al 2003.…”

Hepatitis C Virus Load in Seropositive Liver and Kidney Transplant Recipients by Quantitative Real-Time PCR Before and After Transplantation

“…In a previous survey in Iran, HCV RNA was detected in 6.4% of liver transplant recipients (26). Moreover, the infection in renal transplant recipients varies between 2.6% and 66% in different geographical areas of the world (27)(28)(29).…”

Hepatitis C in Hemodialysis Patients: Current Global Magnitude, Natural History, Diagnostic Difficulties, and Preventive Measures

“…However, HCV-infected renal allograft recipients with abnormal liver function had inferior survival rates. Several other studies [131,132,133,134,135], with the exception of one [136], with shorter than 10-year follow-up periods reported no adverse impact of HCV infection on graft and/or patient survival. The promising results of the aforementioned studies suggest that for many patients, the benefits of renal transplantation outweigh its potential risks imposed by immunosuppression.…”