Transmission of Hepatitis C by Kidney Transplantation—the Risks1

Tesi, Raymond J.; Waller, Katherine; Morgan, Charles G.; Delaney, Stephen; Elkhammas, Elmahdi A; Henry, Mitchell L.; Ferguson, Ronald M.

doi:10.1097/00007890-199403270-00010

Cited by 60 publications

(15 citation statements)

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“…Clinical evaluation of acute graft rejection, cause and date of graft loss, date of transplant, date of acute of rejection, cause and date of death, if it occurred, were recorded. Clinically the presence of liver disease was based on serum ALT levels [28,] a mild abnormality was defined as increase in ALT >65 U/l but <2.5 times the upper limit of normal (ALT levels up to 65 U/l are considered normal in our hospital’s laboratory). Chronic liver disease was defined as a persistent ALT level >2.5 times the upper limit of normal, for more than 6 consecutive months [24, 29].…”

Section: Methodsmentioning

confidence: 99%

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

Mitwalli¹,

Alam

Al-Wakeel³

et al. 2005

Nephron Clin Pract

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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.

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Section: Methodsmentioning

confidence: 99%

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

Mitwalli¹,

Alam

Al-Wakeel³

et al. 2005

Nephron Clin Pract

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“…Because hepatitis C virus (HCV) infection is transmitted through organ transplantation (1)(2)(3)(4)(5) there is almost universal consensus on rejecting kidneys from HCV antibody positive donors (HCVD+) for transplantation in HCV antibody negative recipients (6). However, there is still controversy regarding the use of these kidneys for HCV antibody positive recipients (HCVR+), and some countries even have legal and/or technical provisions in force which preclude the use of these organs.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Experience With Kidney Transplantation From Hepatitis C-Positive Donors Into Hepatitis C-Positive Recipients

Morales

Campistol

Domínguez‐Gil

et al. 2010

American Journal of Transplantation

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Kidney transplantation from hepatitis C virus (HCV)antibody positive donors (HCVD+) into HCV antibody positive recipients (HCVR+) is controversial. We implemented this policy in our units in 1990. Herein, we report the long-term safety of this strategy. From March 1990 to March 2007, 162 HCVR+ received a kidney from HCVD+ (group 1) and 306 from HCVD− (group 2) in our units. Mean follow-up was 74.5 months. Five-and 10-year patient survival was 84.8% and 72.7% in group 1 vs. 86.6% and 76.5% in group 2 (p = 0.250). Three deaths in group 1 and two in group 2 were liver-disease related. Five-and 10-year graft survival was 58.9% and 34.4% versus 65.5% and 47.6% respectively (p = 0.006) while death-censored graft survival was 69% and 47% versus 72.7% and 58.5% (p = 0.055). Decompensated chronic liver disease was similar: 10.3% versus 6.2%. Cox-regression analysis could not identify the donor's HCV serology as a significant risk factor for death, graft failure and severe liver disease in HCVR+. In conclusion, long-term outcome of HCVR+ transplanted with kidneys from HCVD+ seems good in terms of patient survival, graft survival and liver disease. HCVD+ was not a significant risk factor for mortality, graft failure and liver disease among HCVR+. These data strongly suggest that the use of kidneys from HCVD+ in HCVR+ is a safe long-term strategy that helps to prevent kidney loss.

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“…Of the three studies in which donors tested positive for HCV RNA, the transmission rate was 0%-35% when recipients were tested for anti-HCV, 49,106,107 0% when tested for radioimmunoassay, 49 and 0%-57% when tested for HCV RNA. 49,106,107 Seven studies reported the frequency of posttransplant immunoassay testing that varied such that the data were not useful. [50][51][52][53]102,103,108 Eight studies reported de novo HCV infection occurring in 41 recipients 10-60 months posttransplant.…”

Section: Q2e Hcv Transmission From Liver Transplantationmentioning

confidence: 96%

“…[49][50][51][52][53][54][55][99][100][101][102][103][104][105][106][107][108] Studies measured virus transmission applying eight variations in donor and recipient testing, with results ranging from 0% to 100%. Of the three studies in which donors tested positive for HCV RNA, the transmission rate was 0%-35% when recipients were tested for anti-HCV, 49,106,107 0% when tested for radioimmunoassay, 49 and 0%-57% when tested for HCV RNA. 49,106,107 Seven studies reported the frequency of posttransplant immunoassay testing that varied such that the data were not useful.…”

Section: Q2e Hcv Transmission From Liver Transplantationmentioning

confidence: 99%

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PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Transmission through Organ Transplantation

et al. 2013

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Transmission of Hepatitis C by Kidney Transplantation—the Risks1

Cited by 60 publications

References 0 publications

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

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

Long-Term Experience With Kidney Transplantation From Hepatitis C-Positive Donors Into Hepatitis C-Positive Recipients

PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Transmission through Organ Transplantation

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