Hepatitis C infection and survivals of liver transplant patients in Canada, 1997-2003.
BACKGROUND
Liver transplantation is an important health and health care issue for Canadians. Very few studies have estimated the survival results among liver transplant patients infected with hepatitis C virus (HCV) in Canada.


METHODS
We carried out a retrospective cohort study to analyze 1- to 5-year survival rates among liver transplant patients, using Canadian Organ Replacement Registry data (1997-2003). Patients less than 19 years old were excluded from the study. The patients were categorized according to previous HCV infection status. The HCV-positive and HCV-negative groups were compared in the following characteristics: age group, gender, ethnicity, blood groups, donor type, pretransplantation medical status. Survival curves were plotted by Kaplan-Meier method. Stepwise regression model was applied to control the confounding impact related to gender, age, and HCV infection status.


RESULTS
A total of 1842 liver transplant patients were included in the analysis. One-year survival rate for all patients was 85.4%. There were 319 HCV-positive recipients in the exposed group and 813 in the HCV-negative group. The HCV-positive and HCV-negative groups were comparable in age groups, ethnicity, ABO blood group, pretransplantation medical status, and donor organ type. The HCV-positive group had the higher male:female ratio (2.32:1) than the HCV-negative recipients (1.49:1) (Mantel Haenszel (MH) chi2 = 10.0311, P = .0015). There was no significant difference in 1-year survival rate between HCV-positive and HCV-negative groups, but the differences in the 2-year and 5-year survival rates were significant even after adjusting gender factor by stepwise regression analysis (MH chi2 = 4.4203, P = .0355).


CONCLUSIONS
In Canada, the first-year survival rate is about 85.4%, which is comparable with other industrialized countries. The exaggerated survival disadvantage for HCV-positive recipients seems to be middle and long term, not short term.
Hong
Z
Z
Blood Safety Survellance Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada. zhiyong_hong@phac-aspc.gc.ca
Smart
G
G
Dawood
M
M
Kaita
K
K
Wen
S-W
SW
Gomes
J
J
Wu
J
J
D002170:Canada; D005006:Ethnicity; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology* / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012042:Registries; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome