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Long-term effect of hepatitis C virus chronic infection on patient and renal graft survival.
- Source :
-
Transplantation proceedings [Transplant Proc] 2005 Nov; Vol. 37 (9), pp. 3774-7. - Publication Year :
- 2005
-
Abstract
- Background: Hepatitis C virus (HCV) infection increases morbimortality in renal transplantation. The immune response against the HVC is not predictable in a great proportion of patients developing into chronic liver disease, glomerulonephritis, or both.<br />Patients: We analyzed the impact of posttransplant chronic hepatitis development on patient and graft survival in 200 HCV-positive/HBsAg-negative renal allograft recipients transplanted between 1981 and 2003.<br />Results: Ninety-eight patients developed chronic ALT elevation (ALT+), while 102 did not (ALT-). There was no difference in acute rejection episodes (ARE), acute tubular necrosis, donor and recipient age, gender, HLA mismatches, and number of previous renal transplants. Development of ALT+ was associated with a worse patient survival (90% vs 65% at 15 years of follow-up, P = .007; RR = 3.8, CI = 1.4-10.1), an effect that was independent of other variables as time on dialysis and age. The main causes of death among ALT+ were chronic liver disease (52%), cardiovascular (26%), and infection (13%), whereas in ALT- they were cardiovascular (33%), cancer (33%), and chronic liver disease (16%). Conversely, graft survival (censoring for patient death with a functioning graft) was higher among ALT+ (50% vs 35% at 15 years of follow-up, P = .04; RR = 1.5, CI = 1.19-2.22). Causes of graft loss in ALT- patients were chronic allograft nephropathy (CAN, 53%), glomerulonephritis (GN, 18%), acute rejection episode (AR, 22%), and death (5%), whereas among ALT+ they were CAN (36%), GN (31%), ARE (10%), and death (21%; P = .01). By multivariate analysis, ALT- (RR = 1.6, CI = 1.07-2.55, P = .02) and de novo GN (RR = 2, CI = 1.29-3.09, P = .002) were associated with worse renal allograft survival.<br />Conclusion: Our results suggested that a better immune response against the HCV lead to greater patient survival but poorer graft survival.
- Subjects :
- Adult
Cause of Death
Female
Follow-Up Studies
Humans
Kidney Transplantation mortality
Male
Middle Aged
Patient Selection
Retrospective Studies
Survival Analysis
Time Factors
Graft Survival
Hepatitis C, Chronic complications
Kidney Transplantation adverse effects
Kidney Transplantation physiology
Subjects
Details
- Language :
- English
- ISSN :
- 0041-1345
- Volume :
- 37
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Transplantation proceedings
- Publication Type :
- Academic Journal
- Accession number :
- 16386535
- Full Text :
- https://doi.org/10.1016/j.transproceed.2005.09.170