Long-term experience with kidney transplantation from hepatitis C-positive donors into hepatitis C-positive recipients.
Kidney transplantation from hepatitis C virus (HCV) antibody positive donors (HCVD+) into HCV antibody positive recipients (HCVR+) is controversial. We implemented this policy in our units in 1990. Herein, we report the long-term safety of this strategy. From March 1990 to March 2007, 162 HCVR+ received a kidney from HCVD+ (group 1) and 306 from HCVD- (group 2) in our units. Mean follow-up was 74.5 months. Five-and 10-year patient survival was 84.8% and 72.7% in group 1 vs. 86.6% and 76.5% in group 2 (p = 0.250). Three deaths in group 1 and two in group 2 were liver-disease related. Five- and 10-year graft survival was 58.9% and 34.4% versus 65.5% and 47.6% respectively (p = 0.006) while death-censored graft survival was 69% and 47% versus 72.7% and 58.5% (p = 0.055). Decompensated chronic liver disease was similar: 10.3% versus 6.2%. Cox-regression analysis could not identify the donor's HCV serology as a significant risk factor for death, graft failure and severe liver disease in HCVR+. In conclusion, long-term outcome of HCVR+ transplanted with kidneys from HCVD+ seems good in terms of patient survival, graft survival and liver disease. HCVD+ was not a significant risk factor for mortality, graft failure and liver disease among HCVR+. These data strongly suggest that the use of kidneys from HCVD+ in HCVR+ is a safe long-term strategy that helps to prevent kidney loss.
Nephrology Department, Hospital 12 de Octubre, Madrid, Spain. jmorales@h12o.es
J M
JM
Morales
J M
JM
Campistol
B
B
Domínguez-Gil
A
A
Andrés
N
N
Esforzado
F
F
Oppenheimer
G
G
Castellano
A
A
Fuertes
M
M
Bruguera
M
M
Praga
D000328:Adult; D005260:Female; D006085:Graft Survival; D016174:Hepacivirus / Q000276:immunology; D006526:Hepatitis C / Q000601:surgery*; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008107:Liver Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014019:Tissue Donors
D018937:Hepatitis C Antibodies