The Effect of Pretransplant Chronic Hepatitis C Virus Infection Treatment on Graft and Patient Survival in Renal Transplant Recipients

Abstract

Objectives: Studies have demonstrated worse graft and patient survival among hepatitis C virus-positive patients following kidney transplant. Eradication of hepatitis C virus infection before renal transplant with interferon should be considered in hepatitis C virus-infected patients undergoing dialysis who are on the waiting list for transplant. We investigated whether pretransplant hepatitis C virus infection treatment affected graft and patient survival, and we evaluated other contributing factors to these outcomes.

Materials and Methods: We enrolled 83 antihepatitis C virus-positive patients who were diagnosed with chronic hepatitis C virus infection by serology or histopathology and had renal transplant at Baskent University Ankara Hospital from 1982 to 2013. Data were obtained from patient medical files retrospectively. Patients were divided into 2 groups that had or did not have interferon treatment.

Results: In 83 renal transplant patients with chronic hepatitis C virus infection (57 male [69%] and 26 female [31%]), median age was 46 years (range, 26 - 69 y), and most patients were genotype 1-dominant (92%). Interferon monotherapy was received by 30 patients before renal transplant and 28 of 30 patients had long-term follow-up data. There were 14 of 28 patients (50%) who achieved sustained virologic response, and only 1 patient had relapse. Graft survival was significantly lower in patients who had treatment (6 y vs 9 y; P <= .003). However, patient survival rates were similar between groups. Patients who had interferon were younger and had longer hemodialysis duration before renal transplant than patients without treatment. Higher viral load was associated with higher mortality which was caused by sepsis.

Conclusions: Pretransplant hepatitis C virus infection treatment, although recommended before renal transplant, does not always have good outcomes. Pretransplant dialysis treatment period, age of recipient, and posttransplant higher viral replication rates may be important contributing factors related to graft and patient survival.