Hepatitis C Virus Seropositivity at the Time of Renal Transplantation in the United States: Associated Factors and Patient Survival

Abstract

National statistics for patient characteristics and survival of renal transplant recipients positive for hepatitis C virus (HCV+) at the time of renal transplant are presented. A historical cohort analysis of 33479 renal transplant recipients in the United States Renal Data System from 1 July, 1994 to 30 June, 1997 has been carried out. The medical evidence form was also used for additional variables, but because of fewer available values, this was analyzed in a separate model. Outcomes were patient characteristics and survival associated with HCV+. Of 28692 recipients with valid HCV serologies, 1624 were HCV+ at transplant (5.7% prevalence). In logistic regression analysis, HCV+ was associated with African-American race, male gender, cadaveric donor type, increased duration of pre-transplant dialysis, previous transplant, donor HCV+, recipient (but not donor) age, serum albumin, alcohol use, and increased all-cause hospitalizations. Diabetes and IgA nephropathy were less associated with HCV+. Total all-cause, unadjusted mortality was 13.1% in HCV+ vs. 8.5% in HCV- patients (p <0.01 by log rank test). In Cox regression, mortality was higher for HCV+ (adjusted hazard ratio = 1.23, 95% confidence interval = 1.01-1.49, p = 0.04). HCV+ recipients were more likely to be African-American, male, older, and to have received repeat transplants and donor HCV+ transplants. HCV+ recipients also had substantially longer waiting times for transplant. In contrast to recent studies, diabetes did not have an increased association with HCV+, perhaps due to limitations of the database. HCV+ recipients had increased mortality and hospitalization rates compared with other transplant recipients.

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“…8,10 The only other study that used the national database in a manner similar to our study was by Batty and associates in 2001, which studied patients from 1994 to 1997 with a follow-up to 36 months. 17 Their results were similar to ours, and in fact our study extends their results up to the 13-year follow-up available. Hence, despite after 10 years of better surgical techniques, better immunosuppression, better strategies to manage complications, and better selection of HCV+ candidates, the outcomes have not changed.…”

Effect of hepatitis C virus and its treatment on survival

“…9,10 In subsets of patients who have undergone liver transplantation, who have human immunodeficiency virus coinfection, or those on hemodialysis, HCV is associated with significantly shortened survival. [11][12][13][14][15][16] Treatment for chronic HCV has been found to be cost-effective 17 and is associated with sustained viral clearance in approximately 54% to 63% of patients overall. [18][19][20][21] However, the effect of HCV infection itself and its treatment on longterm survival is not well known.…”

Treatment of Hepatitis C Virus Infection in Kidney Transplant Recipients: Case Report

“…1 Renal transplantation remains the best therapeutic option for chronic renal failure (CRF) 2 despite the fact that these patients show worse long-term outcomes due to infectious complications and hepatic failure. 3,4 Allograft half-life is also reduced due to chronic nephropathy, de novo membranoproliferative glomerulonephritis, membranous glomerulonephritis, cryoglobulinemia, and an increased risk of development of diabetes mellitus. 5 HCV therapy is seldom used in transplanted patients, since a cure is only attained in 0% to 50% of cases; furthermore, few individuals achieve the end of the treatment due to the adverse effects (0%-100%).…”