Meta‐analysis of observational studies: hepatitis C and survival after renal transplant

Abstract

Recent evidence has shown that anti-HCV-positive serologic status is significantly linked to lower patient and graft survival after renal transplant, but conflicting results have been given on this point. The aim of this study was to conduct a systematic review of the published medical literature concerning the impact of HCV infection on all-cause mortality and graft loss after RT. The relative risk of all-cause mortality and graft loss was regarded as the most reliable outcome end-point. Study-specific relative risks were weighted by the inverse of their variance to obtain fixed- and random-effect pooled estimates for mortality and graft loss with HCV across the published studies. We identified eighteen observational studies involving 133 530 unique renal transplant recipients. The summary estimate for adjusted relative risk (aRR) of all-cause mortality was 1.85 with a 95% confidence interval (CI) of 1.49; 2.31 (P < 0.0001); heterogeneity statistics, Ri = 0.87 (P-value by Q-test = 0.001). The overall estimate for adjusted RR of all-cause graft loss was 1.76 (95% CI, 1.46; 2.11) (P < 0.0001), heterogeneity statistics, Ri = 0.65 (P-value by Q-test = 0.001). Stratified analysis did not change meaningfully these results. Meta-regression showed that living donor rate had a favourable influence on patient (P = 0.031) and graft survival (P = 0.01), whilst diabetes mellitus having a detrimental role on patient survival (P = 0.001). This meta-analysis of observational studies supports the notion that HCV-positive patients after RT have an increased risk of mortality and graft loss. Further studies are in progress to understand better the mechanisms underlying the relationship between HCV and mortality or graft dysfunction after renal transplant.

Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection: Update 2016

“…144,145 In CH-C patients with ESRD, altered drug pharmacokinetics, increased susceptibility to drug-related toxicity, the requirement for renal transplantation, and a modified course of disease make their treatment difficult. Some of the other issues, which are peculiar to this population of patients, include normal or minimal elevation of transaminases, GT-1 predominance, inaccurate noninvasive assessment of hepatic fibrosis especially with transient elastography, and higher complication rate after liver biopsy.…”

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“…3,[11][12][13] However, a meta-analysis of observational studies in RTRs with HCV demonstrated increased all-cause mortality and all-cause graft loss in these patients. 14 In RTRs who become infected with HCV after transplant, the duration from receiving a transplant to acquiring the infection was an important predictor of survival. 15 In our study, 25 of 37 patients had developed HCV infection after renal transplant.…”

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“…Two meta-analyses have shown that HCV+ kidney transplant recipients have a 79% higher risk of all-cause mortality versus HCVnegative kidney transplant recipients. 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.…”

“…As for graft survival, many previous studies demonstrated that HCV seropositive patients have lower patient and graft survival than seronegative patients after kidney transplant. 8,10 Most of these studies are from the prior decade with older immunosuppression strategies and single center.…”