Hepatitis C virus infection and kidney transplantation: predictors of patient and graft survival.
BACKGROUND
The effect of hepatitis C virus (HCV) infection on patients undergoing kidney transplantation (KTx) is uncertain. This study aimed to evaluate the outcomes of our HCV+/end-stage renal disease (ESRD) patient population based on the therapeutic option including KTx or continuation in dialysis.


METHODS
KTx performed at Virginia Commonwealth University Hospital between January 2000 and December 2004 were tracked prospectively. Forty-three out of a total of 394 KTx patients included in the analysis were HCV+. A group of 52 contemporaneous HCV+/ESRD patients listed, but never transplanted, was also analyzed. HCV-negative transplanted patients were used as the control group.


RESULTS
Patient survival posttransplantation was 81.4% and 68.5% at 1 and 3 years in the HCV+ group, and 97.1% and 92.9% at 1 and 3 years in the HCV- group, respectively (P=0.001). Graft survival was 81.2% and 64.1% at 1 and 3 years in the HCV+ group, and 93.2% and 84.1% at 1 and 3 years posttransplantation in the HCV- group (P=0.01). Univariate analysis identified Knodell score as a predictor of mortality in HCV+ patients (P=0.04). Cox proportional hazards multivariate analysis identified deceased donor (P=0.02), previous kidney transplant (P=0.007), pretransplant diabetes (P=0.05), and Knodell Score (P=0.012) as predictors of patient mortality. Patient survival was superior in HCV+ patients undergoing KTx versus remaining on dialysis.


CONCLUSIONS
Patients with ESRD/HCV+ benefit from KTx without achieving the excellent survival of HCV-/ESRD patients. Liver biopsy is a useful tool to identify advanced liver disease at pretransplantation time.
Maluf
Daniel G
DG
Department of Surgery, Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA 23298-0248, USA. dgmaluf@vcu.edu
Fisher
Robert A
RA
King
Anne L
AL
Gibney
Eric M
EM
Mas
Valeria R
VR
Cotterell
Adrian H
AH
Shiffman
Mitchell L
ML
Sterling
Richard K
RK
Behnke
Martha
M
Posner
Marc P
MP
D001706:Biopsy; D002102:Cadaver; D005260:Female; D005395:Fish Oils / Q000627:therapeutic use; D006085:Graft Survival / Q000502:physiology*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery*; D016030:Kidney Transplantation / Q000502:physiology*; D008099:Liver / Q000473:pathology / Q000821:virology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D005395:Fish Oils; D014280:Triglycerides