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Published on: May 7, 2015
Influence of hepatitis C on renal function after liver transplantation
S Asfandiyar1, M Abouljoud, D Kim
1Department of Gastroenterology, Henry Ford Health Systems, Detroit, Michigan 48202, USA.
Insights
Hepatitis C (HCV) significantly increases the risk of kidney problems after liver transplantation (OLT). Severe HCV infection poses a greater threat, highlighting the need for careful monitoring post-transplant.
Area of Science:
- Nephrology
- Hepatology
- Transplantation
Background:
- Liver transplantation (OLT) is frequently complicated by renal failure.
- Hepatitis C (HCV) is a suspected risk factor for post-OLT renal failure, but direct evidence is limited.
Purpose of the Study:
- To investigate the direct impact of Hepatitis C (HCV) infection on the incidence of renal failure and insufficiency following liver transplantation (OLT).
- To assess whether the severity of recurrent HCV influences renal outcomes after OLT.
Main Methods:
- Retrospective analysis of 349 patients undergoing OLT between 1995 and 2003.
- Categorization of patients into HCV-infected (n=147) and non-HCV-infected (n=202) groups.
- Subgroup analysis of HCV patients into benign (n=114) and severe (n=33) based on fibrosis or cirrhosis; evaluation for renal insufficiency (creatinine >1.8 mg/dL) or renal failure (dialysis/re-transplant).
Main Results:
- Renal failure incidence was significantly higher in HCV patients (10.2%) compared to non-HCV patients (3.5%) (P = .004).
- Patients with severe HCV showed a higher incidence of renal failure (12.1%) than those with mild HCV (9.7%), with a significant trend across non-HCV, mild HCV, and severe HCV groups (P = .012).
- HCV was identified as an independent risk factor for renal failure (RR 2.58, P = .045) on multivariate analysis.
Conclusions:
- Hepatitis C infection is a significant risk factor for renal dysfunction after liver transplantation.
- The severity of recurrent Hepatitis C infection correlates with an increased risk of renal failure and insufficiency post-OLT.
Abstract:
Liver transplantation (OLT) is often complicated by renal failure. Hepatitis C (HCV) is said to be a risk factor for renal failure after OLT, but few studies have analyzed this directly. We evaluated all patients who received a liver transplant from 1995 through 2003. There were 147 patients infected with HCV and 202 not infected. Patients with HCV were further divided into 114 patients with benign HCV and 33 patients with severe HCV defined by bridging fibrosis or cirrhosis. The groups were evaluated for the development of renal insufficiency defined as a creatinine above 1.8 mg/dL on three consecutive occasions or renal failure as defined by the need for dialysis or renal transplant. The incidence of renal failure in patients with HCV was 10.2% and in patients without HCV was 3.5% (P = .004). Patients with severe HCV had an incidence of 12.1% vs 9.7% for patients with mild HCV. The linear trend in renal failure from non-HCV to mild HCV to severe HCV was significant (P = .012). The incidence of renal insufficiency was 23.4% in patients with HCV and 14.9% in patients without HCV (P = .080). The incidence was 32.3% in patients with severe HCV and 20.6% in patients with mild HCV. The trend in renal insufficiency across the three groups was mildly significant (P = .042). On multivariate analysis, HCV was a risk factor for renal failure with a relative risk of 2.58 (P = .045). The study suggests that HCV and the severity of recurrent HCV are risk factors for renal dysfunction after liver transplantation.
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