Long-term effect of hepatitis C virus chronic infection on patient and renal graft survival.
BACKGROUND
Hepatitis C virus (HCV) infection increases morbimortality in renal transplantation. The immune response against the HVC is not predictable in a great proportion of patients developing into chronic liver disease, glomerulonephritis, or both.


METHODS
We analyzed the impact of posttransplant chronic hepatitis development on patient and graft survival in 200 HCV-positive/HBsAg-negative renal allograft recipients transplanted between 1981 and 2003.


RESULTS
Ninety-eight patients developed chronic ALT elevation (ALT+), while 102 did not (ALT-). There was no difference in acute rejection episodes (ARE), acute tubular necrosis, donor and recipient age, gender, HLA mismatches, and number of previous renal transplants. Development of ALT+ was associated with a worse patient survival (90% vs 65% at 15 years of follow-up, P = .007; RR = 3.8, CI = 1.4-10.1), an effect that was independent of other variables as time on dialysis and age. The main causes of death among ALT+ were chronic liver disease (52%), cardiovascular (26%), and infection (13%), whereas in ALT- they were cardiovascular (33%), cancer (33%), and chronic liver disease (16%). Conversely, graft survival (censoring for patient death with a functioning graft) was higher among ALT+ (50% vs 35% at 15 years of follow-up, P = .04; RR = 1.5, CI = 1.19-2.22). Causes of graft loss in ALT- patients were chronic allograft nephropathy (CAN, 53%), glomerulonephritis (GN, 18%), acute rejection episode (AR, 22%), and death (5%), whereas among ALT+ they were CAN (36%), GN (31%), ARE (10%), and death (21%; P = .01). By multivariate analysis, ALT- (RR = 1.6, CI = 1.07-2.55, P = .02) and de novo GN (RR = 2, CI = 1.29-3.09, P = .002) were associated with worse renal allograft survival.


CONCLUSIONS
Our results suggested that a better immune response against the HCV lead to greater patient survival but poorer graft survival.
Bestard
O
O
From the Servei de Nefrologia, Hospital Universitari de Bellvitge, University of Barcelona, Spain.
Cruzado
J M
JM
Torras
J
J
Gil-Vernet
S
S
Serón
D
D
Moreso
F
F
Rama
I
I
Grinyó
J M
JM
D000328:Adult; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors