title: Outcome of hepatitis C virus-infected kidney transplant candidates who remain on the waiting list.
abstract: The management of patients awaiting transplantation is a growing concern. This retrospective cohort study examined outcomes of hepatitis C virus (HCV)-infected kidney candidates who remain waitlisted. Records from 315 HCV+ kidney candidates evaluated between 1992 and 2002, were reviewed. A total of 300 (95.1%) patients were receiving renal replacement therapy at evaluation, median duration 48.2 + 4.3 months. The diabetes prevalence was 42.9% in HCV+ candidates, compared to 35.9% among 602 currently listed HCV- patients (p = 0.023). Liver disease, defined by abnormal hepatic biochemistry or histology, was observed in 59% patients. Median post-evaluation follow-up was 1440 +/- 75 days; 138 candidates were transplanted. Kaplan-Meier survival was higher among transplanted than non-transplanted patients (p = 0.003). Of 177 patients not transplanted, 76 were delisted, mostly due to death (45%) and non-compliance (28%), infrequently because of liver disease (8.8%). A Cox regression model was fit to examine risk factors for waitlist death; only diabetes was associated (HR: 2.17, 95% CI: 1.1-4.1, p = 0.02), while liver disease was not. This study demonstrates that, in waitlisted HCV+ kidney patients, diabetes occurs with increased prevalence and is a major mortality determinant. Diabetic HCV+ kidney candidates are therefore a patient subgroup that requires frequent and careful reevaluation to ensure ongoing transplantability.
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. rdbloom@mail.med.upenn.edu
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloom
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sayer
authors.forename: Kosunarty
authors.initials: K
authors.lastname: Fa
authors.forename: Serban
authors.initials: S
authors.lastname: Constantinescu
authors.forename: Peter
authors.initials: P
authors.lastname: Abt
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000378:metabolism*; D006526:Hepatitis C / Q000401:mortality / Q000628:therapy*; D006801:Humans; D016030:Kidney Transplantation; D008099:Liver / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists