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Intermediate-term outcomes of hepatitis C-positive compared with hepatitis C-negative deceased-donor renal allograft
Kristian L Brown1, Jose M El-Amm, Mona D Doshi
1Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Insights
Hepatitis C virus (HCV) positive kidney transplant patients had similar survival but lower graft survival. Noncompliance and specific kidney disease (MPGN) contributed to graft loss, with steroids potentially increasing diabetes risk.
Area of Science:
- Nephrology
- Transplantation Immunology
- Infectious Diseases
Background:
- Conflicting data exists regarding hepatitis C virus (HCV) impact on renal transplant outcomes.
- Understanding HCV's role is crucial for optimizing post-transplant care.
Purpose of the Study:
- To investigate the effect of HCV positivity on kidney transplant patient and graft survival.
- To identify specific complications and risk factors associated with HCV in renal transplant recipients.
Main Methods:
- Retrospective analysis of kidney transplant recipients, comparing HCV-positive (n=34) and HCV-negative (n=111) predominantly African American patients.
- Utilized contemporary immunosuppression protocols.
- Compared patient survival, acute rejection rates, graft survival, new-onset diabetes mellitus (NODM), and causes of graft loss.
Main Results:
- No significant difference in patient survival or acute rejection between HCV-positive and HCV-negative groups.
- HCV-positive recipients showed increased incidence of NODM and decreased graft survival.
- Graft loss in HCV-positive patients was attributed to noncompliance and Type I MPGN.
- NODM incidence was higher in HCV-positive patients on prednisone (47%) compared to HCV-negative patients (25%).
Conclusions:
- HCV-positive kidney transplant recipients have comparable patient survival but reduced graft survival.
- Noncompliance and Type I MPGN are key factors in poorer graft outcomes.
- Corticosteroid use may exacerbate the diabetogenic effects of HCV in kidney transplant patients.
Background:
Prior studies have yielded conflicting results concerning the impact of HCV on renal transplant outcomes.
Methods:
We examined outcomes in comparable groups of predominantly African American hepatitis C virus (HCV)-positive (n = 34) and HCV-negative (n = 111) kidney transplant patients receiving contemporary immunosuppression.
Results:
There was no difference in patient survival or acute rejection, but new-onset diabetes (NODM) was increased and graft survival decreased in the HCV-positive group, with increased graft loss secondary to noncompliance and Type I MPGN. The incidence of NODM among patients undergoing early corticosteroid withdrawal was 11% in both groups, while among those on prednisone, it was 47% in HCV-positive versus 25% in HCV-negative recipients.
Conclusions:
Deceased-donor HCV-positive renal allograft recipients have equivalent patient but decreased graft survival. Noncompliance and Type I MPGN play a role in producing this negative effect on graft outcome. Steroids may be required for HCV to exert its diabetogenicity in kidney transplant patients.
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