Impact of HCV infection on first cadaveric renal transplantation, a single center experience.
BACKGROUND
Controversy still persists regarding the impact of HCV infection on renal transplant recipients. This study aimed to evaluate the effect of anti-HCV antibody status on patients and grafts of renal transplants at a single center.


METHODS
We examined 299 first cadaveric renal transplants performed between July 1981 and May 2000 at our hospital, including 129 patients with anti-HCV antibody positive (HCV+ group) and 170 patients with anti-HCV antibody negative (HCV- group). The HBsAg of the 299 patients were all negative throughout the follow-up period. Causes of graft failure and patient death were analyzed. Patient and graft cumulative survival were compared between HCV+ and HCV- groups. Multivariate analysis with Cox proportional hazard model were calculated for risk hazards of outcome.


RESULTS
Overall cumulative patient survival was 97.72, 85.63 and 71.31% at 1, 10, and 15 yr, respectively, in the HCV+ group, compared with 95.02, 67.85 and 59.83% at 1, 10 and 15 yr, respectively, in the HCV- group (p = 0.014). The major cause of patient death in both groups was infection with 26.67% in HCV+ group and 60.87% in HCV- group. Cumulative graft survival in the HCV+ group revealed 92.26, 55.97 and 26.16% at 1, 10 and 15 yr, respectively, compared with 88.07, 58.34 and 58.32% at 1, 10 and 15 yr, respectively, in the HCV- group (p = 0.700). The major cause of graft failure was chronic allograft dysfunction (56.82%) in HCV+ group, and patient death (32.43%) in the HCV- group. Multivariate analysis of patient survival revealed anti-HCV antibody+ had lesser risk hazard (aRR: 0.30, p = 0.002), chronic hepatitis had higher risk hazard (aRR: 1.90, p = 0.135), male recipient had higher risk hazard (aRR: 2.18, p = 0.051), and older recipients (age >55) also had higher risk hazard (aRR: 4.21, p = 0.063). Analysis of graft survival revealed only older donors (age >35) had higher risk hazard (aRR: 1.90, p = 0.081).


CONCLUSIONS
The study revealed that patients with anti-HCV antibody had higher incidence of chronic hepatitis, chronic allograft dysfunction and post-transplantation nephrotic syndrome. Graft survival tended lower in the very long time. However, patients with anti-HCV antibodies had better patient survival when compared with patients without HCV antibodies up to 15 yr follow up. Patients of hepatitis C group without clinical chronic hepatitis was associated with best patient survival.
Lin
Hsin-Hung
HH
Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.
Huang
Chiu-Ching
CC
Huang
Jeng-Yi
JY
Yang
Chih-Wei
CW
Wu
Mai-Szu
MS
Fang
Ji-Tseng
JT
Yu
Chun-Chen
CC
Chiang
Yang-Jen
YJ
Chu
Sheng-Hsieh
SH
D000328:Adult; D002102:Cadaver; D005260:Female; D006085:Graft Survival / Q000276:immunology; D006526:Hepatitis C / Q000150:complications / Q000276:immunology*; D018937:Hepatitis C Antibodies / Q000276:immunology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000276:immunology / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis
D018937:Hepatitis C Antibodies