title: Harmful effects of viral replication in seropositive hepatitis C virus renal transplant recipients.
abstract: BACKGROUND
  Seropositivity for hepatitis C virus (HCV) predicts lower patient and graft survival after renal transplantation (RT). However, the influence of viral replication at transplantation on long-term outcome remains to be determined.
  
  
  METHODS
  This was a retrospective study conducted in four Spanish hospitals, from 1997 to 2006. Data of all patients with RT, who displayed HCV+ (enzyme-linked immunosorbent assay), and with negative viremia at RT (NEG group) were collected (n=41). For each NEG patient enrolled, data of two patients with RT nearest in time, HCV+, and positive viremia (POS group) were also collected (n=78).
  
  
  RESULTS
  The POS group showed a higher incidence of long-term liver disease (56.4% vs. 24.4%, P=0.0009) and episodes of transaminase elevation (38.5% vs. 7.3%, P=0.0003) and worse renal function (serum creatinine [sCr], 3.0 [2.7] vs. 1.9 [1.6] mg/dl, P=0.032; glomerular filtration rate, 43.7 [22.4] vs. 56.9 [27.9] ml/min, P=0.075). Noteworthy, 24.4% of NEG patients reactivated after RT, showing a worse patient survival (P=0.039). Active viral replication at RT and dialysis requirement in the first week remained as independent predictors of lower graft survival (death censored): hazards ratio, 3.11 (95% confidence interval, 1.34-7.19; P=0.009) and hazards ratio 3.13 (95% confidence interval, 1.53-6.37; P=0.002).
  
  
  CONCLUSIONS
  This study shows that active viral replication at transplantation is an independent risk factor for graft failure in patients with positive serology for HCV.
authors.affiliation: Renal Transplant Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain. mgentil@cica.es
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gentil Govantes
authors.forename: Núria
authors.initials: N
authors.lastname: Esforzado
authors.forename: Josep M
authors.initials: JM
authors.lastname: Cruzado
authors.forename: Francisco M
authors.initials: FM
authors.lastname: González-Roncero
authors.forename: Montserrat
authors.initials: M
authors.lastname: Balaña
authors.forename: Núria
authors.initials: N
authors.lastname: Saval
authors.forename: José M
authors.initials: JM
authors.lastname: Morales
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D016174:Hepacivirus / Q000235:genetics / Q000254:growth & development* / Q000276:immunology; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy / Q000821:virology; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome; D014766:Viremia; D014779:Virus Replication
chemical_list: D015415:Biomarkers; D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D003404:Creatinine; D000637:Transaminases