Impact of hepatitis B and C on graft loss and mortality of patients after kidney transplantation.
BACKGROUND
Mortality or graft loss after renal transplantation might be influenced by hepatitis virus infection.


METHODS
Sera from time of transplantation of 927 renal transplant recipients were tested for hepatitis C (HCV) and hepatitis B virus (HBV) in order to investigate the impact of hepatitis virus infection on graft loss and mortality over an observation period of 20 yr.


RESULTS
One hundred and twenty three of 927 patients were HCV positive, 30 patients HBV positive and seven patients HBV and HCV positive. The observation period was 9.2 +/- 4.4 yr. Mortality was significantly higher in patients with hepatitis B (p = 0.0005), as well as in patients with concomitant B and C hepatitis (p < 0.0001) and in those who acquired HCV infection after transplantation (n = 30, p = 0.0192) compared with non-infected patients. Patients with replicating HBV infection (HBeAg positive) had the worst prognosis (p < 0.0001). In the multivariate analysis the presence of HBeAg (p < 0.0001), patients' age (p < 0.0001) and HCV infection after transplantation (p = 0.0453) were predictors for death. Graft survival was significantly shorter in patients with concomitant hepatitis B and C (p = 0.0087) as well as in HBeAg positive patients (p = 0.002). HCV infection or HBs antigenemia did not have a significant impact on graft survival compared with non-infected patients.


CONCLUSIONS
HCV infection after transplantation is associated with a high mortality whereas chronic HCV infection before trans plantation does not have a significant impact on mortality. Patients with replicating HBV infection or concomitant HBV and HCV infection have a high risk of graft loss and mortality.
Breitenfeldt
Marie K
MK
Department of Nephrology, Albert-Ludwigs-University Freiburg, Germany. breitenfeldt@med1.ukl.uni-freiburg.de
Rasenack
Jens
J
Berthold
Hans
H
Olschewski
Manfred
M
Schroff
Joachim
J
Strey
Christoph
C
Grotz
Wolfgang H
WH
D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000821:virology; D006085:Graft Survival; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis*; D006511:Hepatitis B Antigens / Q000097:blood; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D012307:Risk Factors; D015996:Survival Rate
D006511:Hepatitis B Antigens; D018937:Hepatitis C Antibodies