Should hepatitis C virus infection be a contraindication to renal transplantation?

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Abstract

BACKGROUND

The influence of hepatitis C virus (HCV) infection on the success of kidney transplantation remains controversial.

OBJECTIVE

To establish whether the outcomes of kidney transplant recipients are affected by the presence of HCV infection.

DESIGN AND INTERVENTION

This retrospective analysis included data from patients who received a kidney graft at the Hospital Universitario San Vicente de Paúl, Medellín, Colombia during the period August 1973 to November 2000.HIV infection, alcoholism, drug abuse and mental impairment were exclusion criteria for transplantation. Patients who tested positive for hepatitis B surface antigen were excluded from the analysis. Immunosuppression generally comprised methylprednisolone, ciclosporin and azathioprine; trimethoprim-sulfamethoxazole was also administered for 6 months after transplantation. Outcomes were compared between patients diagnosed with HCV infection (based on clinical and laboratory findings) and those without HCV infection.

OUTCOMES MEASURE

Mean duration and 5-year rates of graft and patient survival were assessed.

RESULTS

Of the 2,073 patients who underwent transplantation during the study period, 208 were eligible for this analysis (144 without HCV infection; 64 with HCV infection). Most base-line demographic and clinical characteristics were not significantly different between the HCV-negative and HCV-positive patients: the mean age at diagnosis was 33.9 years and 35.7 years, respectively; and the mean duration of renal replacement therapy was 15.3 months and 9.9 months, respectively. More HCV-negative than HCV-positive patients received triple immunosuppression (70.1% vs 42.1%;P =0.001),because azathioprine was withheld from many of the latter to avoid possible hepatotoxicity. Mycophenolate was used in 7.6%of HCV-negative patients, but no HCV-positive patients received this therapy. Transfusions after transplantation were more frequent in the patients with HCV infection than in those without (mean 0.80 vs 0.40 per patient;P =0.001).The frequency of graft rejection did not differ between the groups. Mean patient survival in the 96 HCV-negative and the 39 CV-positive recipients f living-donor kidneys was 52.7 months and 52.5 months, respectively; 5-year survival rates were 77% and 71%, respectively. Mean patient survival in the 48 HCV-negative and the 25 HCV-positive recipients of deceased-donor kidneys was 51.1 months and 43.6 months, respectively; 5-year survival rates were 72%and 55%, respectively. Mean graft survival in the living-donor kidney recipients was 48.9 months in the HCV-negative subset and 49.9 months in the HCV-positive subset; 5-year graft survival rates were 66%and 61%, respectively. Mean graft survival in the deceased-donor kidney recipients was 41.2 months in the HCV-negative subset and 37.6 months in the HCV-positive subset; 5-year graft survival rates were 41%and 44%, respectively.

CONCLUSION

The outcomes of renal transplant recipients do not seem to be substantially worsened by the presence of HCV infection.

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