title: Hepatitis C infection, time in renal-replacement therapy, and outcome after kidney transplantation.
abstract: BACKGROUND
  Hepatitis C virus (HCV) infection is common in kidney transplantation and is known to affect long-term patient and graft survival, as is time in renal-replacement therapy (RRT). The aim of this study was to investigate HCV in relation to time in RRT and its impact on outcome after transplantation.
  
  
  METHODS
  A follow-up cohort study using Kaplan-Meier analysis and Cox proportional hazards model was performed in 545 kidney and 26 kidney-pancreas transplant recipients receiving transplants between 1989 and 1997, with last follow-up on December 31, 2002. HCV status at transplantation and time in RRT were analyzed.
  
  
  RESULTS
  Time in RRT was significantly longer (P<0.0001), and previous transplantations were more common (P=0.04) in the HCV-positive group. HCV significantly reduced patient (P=0.0012) and graft survival (P=0.0003) after transplantation. Adjustment for age, sex, diabetes, previous transplantations, type of transplant, and time in RRT resulted in a relative risk (RR) for death of 2.23, 1.92, and 1.07 for HCV, diabetes, and age, respectively. The RR for graft loss was 1.96 and 1.03 for HCV and age. Sex, previous transplants, and time in RRT did not affect HCV as an independent risk factor for patient or graft survival. The leading cause of death was cardiovascular disease in both groups.
  
  
  CONCLUSIONS
  HCV was, in our series, more important than time in RRT for patient death and graft loss posttransplant. Successful pretransplant antiviral therapy could be more beneficial for HCV-infected patients rather than early transplantation for long-term outcome, but this needs to be studied prospectively.
authors.affiliation: Division of Renal Medicine, Department of Clinical Science, Center for Surgical Sciences, Karolinska Institute and Huddinge University Hospital, 141 86 Stockholm, Sweden. Annette.Bruchfeld@klinvet.ki.se
authors.forename: Annette
authors.initials: A
authors.lastname: Bruchfeld
authors.forename: Henryk
authors.initials: H
authors.lastname: Wilczek
authors.forename: Carl-Gustaf
authors.initials: CG
authors.lastname: Elinder
mesh_terms: D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006526:Hepatitis C / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017582:Renal Replacement Therapy / Q000009:adverse effects*; D016019:Survival Analysis; D016896:Treatment Outcome