Impact of hepatitis B and C virus on kidney transplantation outcome

Abstract

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...

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

“…There were no interactions between HCVπ and allograft rejection or induction antibody therapy. In contrast to prior studies by Mathurin et al (11), AfricanAmerican race was not significant (p Ω0.41, hazard ratio Ω 1.05, 95% confidence interval Ω 0.94-1.17). Other covariates in the analysis significantly associated with mortality were greater duration of pre-transplant dialysis, cadaveric donor, previous transplant, diabetes, recipient age, and donor age.…”

“…At 2 years post-transplant, patient survival for both groups in the Mathurin et al (11) study was higher than in the present study, as might be expected in comparing a national with a single-center study and the lower percentage of diabetic patients transplanted (8.0% in Mathurin et al vs. 25.8% in the present study). However, if magnified, the separation of curves appears similar in Figure 1 of the present study and Figure 4 of Mathurin et al (11). The continued significance of positive hepatitis C serology on outcomes in the present study persisted after accounting for recipients of African ancestry, also in agreement with Mathurin et al's (11) study.…”

“…However, patients in this study routinely received antilymphocyte induction therapy, which in preliminary reports has been linked with increased mortality in HCVπ recipients (22), although it was not a significant interaction term in the present analysis. A larger study by Mathurin et al (11) had similar findings; in fact, the survival curves for HCVπ and HCV-patients began to separate at 3 years post-transplant. At 2 years post-transplant, patient survival for both groups in the Mathurin et al (11) study was higher than in the present study, as might be expected in comparing a national with a single-center study and the lower percentage of diabetic patients transplanted (8.0% in Mathurin et al vs. 25.8% in the present study).…”

“…A larger study by Mathurin et al (11) had similar findings; in fact, the survival curves for HCVπ and HCV-patients began to separate at 3 years post-transplant. At 2 years post-transplant, patient survival for both groups in the Mathurin et al (11) study was higher than in the present study, as might be expected in comparing a national with a single-center study and the lower percentage of diabetic patients transplanted (8.0% in Mathurin et al vs. 25.8% in the present study). However, if magnified, the separation of curves appears similar in Figure 1 of the present study and Figure 4 of Mathurin et al (11).…”

“…However, the course of patients with endstage renal disease (ESRD) who are seropositive for hepatitis C virus (HCVπ) is incompletely characterized (7). Most studies agree that HCVπ ESRD patients have reduced survival compared with other ESRD patients, whether on dialysis or after renal transplantation, although this difference is usually apparent only after several years (8)(9)(10)(11). At least one study has shown that HCVπ patients had better survival after renal transplantation compared with HCVπ patients on the transplant waiting list (12).…”