The impact of hepatitis C virus viremia on renal graft and patient survival: a 9-year prospective study.

Background: The impact of hepatitis C virus (HCV) infection on long-term patient and renal graft survival is controversial.

Methods: We prospectively followed up for approximately 9 years 133 hepatitis B surface antigen (HBsAg)-negative successive renal transplant recipients for whom HCV RNA polymerase chain reaction (PCR) results were available before transplantation. We compared graft and patient survival rates and causes of death and graft failure in PCR-positive and PCR-negative transplant recipients. Cox proportional hazards models were used to detect the impact of HCV infection on patient and graft survival. We also studied posttransplantation hepatic function and graft performance.

Results: HCV RNA was detected in sera of 87 patients (65%). Univariate and multivariate analyses did not show an increased risk for death or graft failure in viremic compared with nonviremic transplant recipients. However, HCV-infected transplant recipients with chronic alanine aminotransferase level elevations had increased risks for death (odds ratio, 3.7; 95% confidence interval [CI], 1 to 13.7) and graft failure (odds ratio, 3; 95% CI, 1.4 to 6.7) compared with viremic transplant recipients with persistently normal liver function test results and noninfected patients. Five viremic and no nonviremic transplant recipients died of liver disease. HCV viremic transplant recipients had significantly greater frequencies of biochemical chronic liver disease, proteinuria, and biopsy-proven chronic allograft nephropathy (CAN) compared with noninfected transplant recipients.

Conclusion: HCV infection per se has no adverse effect on long-term renal graft and patient survival. However, HCV-infected transplant recipients with abnormal liver function have inferior survival rates. HCV infection in renal transplants is associated with greater rates of proteinuria and CAN.