title: The impact of hepatitis C virus viremia on renal graft and patient survival: a 9-year prospective study.
abstract: BACKGROUND
  The impact of hepatitis C virus (HCV) infection on long-term patient and renal graft survival is controversial.
  
  
  METHODS
  We prospectively followed up for approximately 9 years 133 hepatitis B surface antigen (HBsAg)-negative successive renal transplant recipients for whom HCV RNA polymerase chain reaction (PCR) results were available before transplantation. We compared graft and patient survival rates and causes of death and graft failure in PCR-positive and PCR-negative transplant recipients. Cox proportional hazards models were used to detect the impact of HCV infection on patient and graft survival. We also studied posttransplantation hepatic function and graft performance.
  
  
  RESULTS
  HCV RNA was detected in sera of 87 patients (65%). Univariate and multivariate analyses did not show an increased risk for death or graft failure in viremic compared with nonviremic transplant recipients. However, HCV-infected transplant recipients with chronic alanine aminotransferase level elevations had increased risks for death (odds ratio, 3.7; 95% confidence interval [CI], 1 to 13.7) and graft failure (odds ratio, 3; 95% CI, 1.4 to 6.7) compared with viremic transplant recipients with persistently normal liver function test results and noninfected patients. Five viremic and no nonviremic transplant recipients died of liver disease. HCV viremic transplant recipients had significantly greater frequencies of biochemical chronic liver disease, proteinuria, and biopsy-proven chronic allograft nephropathy (CAN) compared with noninfected transplant recipients.
  
  
  CONCLUSIONS
  HCV infection per se has no adverse effect on long-term renal graft and patient survival. However, HCV-infected transplant recipients with abnormal liver function have inferior survival rates. HCV infection in renal transplants is associated with greater rates of proteinuria and CAN.
authors.affiliation: Nephrology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. uronef@hotmail.com
authors.forename: Ihab M
authors.initials: IM
authors.lastname: Mahmoud
authors.forename: Ahmed F
authors.initials: AF
authors.lastname: Elhabashi
authors.forename: Esam
authors.initials: E
authors.lastname: Elsawy
authors.forename: Amr A
authors.initials: AA
authors.lastname: El-Husseini
authors.forename: Gamal E
authors.initials: GE
authors.lastname: Sheha
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Sobh
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality*; D008111:Liver Function Tests; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D016019:Survival Analysis; D014766:Viremia
chemical_list: D012367:RNA, Viral