title: The long-term outcomes of hepatitis C virus core antigen-positive Japanese renal allograft recipients.
abstract: BACKGROUND
  The impact of hepatitis C virus (HCV) infections on patient long-term survival after renal transplants is unclear.
  
  
  METHODS
  To clarify the long-term outcomes of Japanese renal allograft recipients with HCV infections, we studied the cases of 187 patients (118 males and 69 females; 155 living donor cases, and 32 deceased donor cases; median follow-up period: 250 months) who underwent an initial renal transplant at Kanazawa Medical University from 1974 onwards.
  
  
  RESULTS
  In this cohort, 35 patients (18.7%) were HCV core antigen (Ag)-positive, and 13 of them (37.1%) died (due to liver cirrhosis (4 cases), hepatocellular carcinoma (1 case), fibrosing cholestatic hepatitis due to HCV (1 case), and infections complicated with chronic hepatitis (6 cases)). However, only 14 of the 145 (9.7%) recipients died in the HCV-Ag/HCV antibody (Ab)-negative group. The Kaplan-Meier life table method indicated that the HCV-infected group exhibited significantly lower patient and death-censored allograft survival rates (log-rank test; patient survival: Chi-square: 11.2, p = 0.004; graft survival: Chi-square: 25.7, p < 0.001). The survival rate of the HCV-Ag-positive recipients decreased rapidly at 240 months after the renal transplant procedure. In addition, a Cox proportional hazards model indicated that positivity for the HCV-Ag was the most important independent risk factor for post-renal transplant survival and allograft function [survival: hazard ratio (HR) 3.93 (1.54-10.03), p = 0.004; graft function: HR 2.09 (1.14-3.81), p = 0.016].
  
  
  CONCLUSIONS
  HCV infection is a harmful risk factor for patient survival (especially at ≥20 years post-renal transplant) and renal allograft function in allograft recipients.
authors.affiliation: Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan. taro1985@kanazawa-med.ac.jp.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Okino
authors.affiliation: Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Okushi
authors.affiliation: Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Mukai
authors.affiliation: Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Matsui
authors.affiliation: Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Hayashi
authors.affiliation: Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Fujimoto
authors.affiliation: Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Adachi
authors.affiliation: Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Yamaya
authors.affiliation: Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan. h-yoko@kanazawa-med.ac.jp.
authors.forename: Hitoshi
authors.identifier: http://orcid.org/0000-0002-7753-1366
authors.initials: H
authors.lastname: Yokoyama
mesh_terms: D000328:Adult; D064591:Allografts; D002423:Cause of Death; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000821:virology*; D006085:Graft Survival; D006526:Hepatitis C / Q000097:blood / Q000453:epidemiology*; D018936:Hepatitis C Antigens / Q000097:blood; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016030:Kidney Transplantation; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality / Q000821:virology*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018936:Hepatitis C Antigens
keywords: Core antigen; Graft loss; Hepatitis C virus; Renal transplantation; Survival rate