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Impact of hepatitis B and C virus on kidney transplantation outcome
P Mathurin1, C Mouquet, T Poynard
1Service d'Urologie, Hôpital Pitié-Salpêtrière, Paris, France.
Insights
Hepatitis B (HBV) and C (HCV) significantly impact kidney transplant patient survival. Cirrhosis, HCV, and age are key prognostic factors, necessitating careful patient selection and monitoring for improved outcomes.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Immunology
Background:
- The impact of hepatitis B (HBV) and C (HCV) on renal transplant outcomes remains debated.
- Assessing prognostic factors is crucial for optimizing patient and graft survival post-transplantation.
Purpose of the Study:
- To evaluate the independent prognostic significance of HBsAg and anti-HCV in kidney transplant recipients.
- To compare outcomes between infected and non-infected patients matched for potential confounders.
- To determine the prognostic value of biopsy-proven cirrhosis in this population.
Main Methods:
- Retrospective analysis of 834 kidney transplant recipients.
- Categorization into HBsAg-positive, anti-HCV-positive, and seronegative groups.
- Case-control study to compare infected and matched non-infected patients.
- Survival analysis assessing prognostic factors including age, year of transplant, cirrhosis, and viral markers.
Main Results:
- Ten-year survival rates were significantly lower for HBsAg-positive (55%) and anti-HCV-positive (65%) patients compared to seronegative patients (80%).
- Independent prognostic factors for 10-year patient survival included age at transplantation, year of transplantation, biopsy-proven cirrhosis, and presence of HCV antibodies.
- Case-control analysis identified age, HBsAg, and anti-HCV as independent predictors of patient and graft survival.
Conclusions:
- Hepatitis C virus (HCV) infection, biopsy-proven cirrhosis, and recipient age are independent negative prognostic factors for 10-year survival after kidney transplantation.
- Hepatitis B virus (HBV) and HCV serological markers are independently associated with reduced patient and graft survival.
- Routine liver histology in infected patients may improve pre-transplant patient selection.
Abstract:
The impact of hepatitis B (HBV) and C (HCV) on patient survival after kidney transplantation is controversial. The aims of this study were (1) to assess the independent prognostic values of HBsAg and anti-HCV in a large renal transplant population, (2) to compare infected patients with noninfected patients matched for factors possibly associated with graft and patient survival, and (3) to assess the prognostic value of biopsy-proven cirrhosis. Eight hundred thirty-four transplanted patients were included: 128 with positive HBsAg (group I), 216 with positive anti-HCV (group II), and 490 without serological markers of HBV and HCV (group III). Fifteen percent and 29% of patients were HBsAg-positive and anti-HCV-positive, respectively. Ten-year survivals of group I (55 +/- 6%) and group II (65 +/- 5%) were significantly lower than survival of group III (80 +/- 3%, P <.001). At 10 years, among overall patients with HCV screening (n = 834), four variables had independent prognostic values in patient survival: age at transplantation (P <.0001), year of transplantation (P =.02), biopsy-proven cirrhosis (P =.03), and presence of HCV antibodies (P =.02). In the case control study, comparison of infected patients with their matched control patients showed that age at transplantation (P <.05), HBsAg (P =.005), and anti-HCV (P =.005) were independent prognostic factors. HCV, biopsy-proven cirrhosis, and age are independent prognostic factors of 10-year survival in patients with kidney grafts. The case-control study showed that anti-HCV and HBsAg were independently associated with patient and graft survivals. In infected patients, a routine liver histological analysis would improve selection of patients for renal transplantation.