PREDICTORS OF PATIENT AND GRAFT SURVIVAL ON HCV PATIENTS UNDERGOING KIDNEY TRANSPLANTATION.Room: Hall C
Daniel G Maluf, Robert A Fisher, Anne L King, Eric M Gibney, Valeria R Mas, Adrian H Cotterell, Richard T Stravitz, Richard K Sterling, Mitchell L Shiffman, Martha Bencke, Marc P Posner. Surgery/Transplantation, Virginia Commonwealth University, Richmond, VA; Medicine/Nephrology, Virginia Commonwealth University, Richmond, VA; Medicine/Hepatology, Virginia Commonwealth University, Richmond, VA.
Background: The impact of hepatitis C virus (HCV) infection on long-term renal patient and graft survival remains controversial. This study aimed to identify predictors of patient and graft survival on HCV patients (pts) undergoing kidney transplantation (KT).
Methods: Data collected prospectively of KT pts between January 1999 and December 2004 (N=394), including 43 pts HCV + (by PCR) and 351 pts with HCV- was analyzed. HCV+ patients underwent liver biopsy prior to transplantation. Causes of graft failure and patient death were analyzed. Cumulative patient and graft survival were compared between HCV+ and HCV- groups. Multivariate analysis utilizing Cox proportional hazard model was calculated for risk hazards on outcome. Knodell Score and fibrosis Score from the pre-transplant liver biopsy was used to determine degree of liver disease.
Results: Overall cumulative patient survival was 81.4% and 68.5% at 1 and 3 yrs, respectively, in the HCV+ group, compared with 97.1% and 92.9% at 1 and 3 yrs, respectively, in the HCV- group (p = 0.001). Graft survival was lower in patients with HCV vs. non-HCV as well: 81.2% vs. 93.2% at 1 year, and 64.1% vs. 84.1% at 3 yrs (p= 0.001). Infection was a common cause of death in both groups. However, infection was significantly more frequent in the HCV+ group (72.7%) when compared with the HCV - group (22.2%) (p= 0.007).
On HCV + pts, univariate analysis identified Knodell score as a risk factor for mortality in HCV + pts (p= 0.04). Cox proportional hazards multivariate analysis identified deceased donor (p= 0.02), previous kidney transplantation (p= 0.007), pre-transplant diabetes (p=0.05) and Knodell Score > 5 (p=0.05) as predictors of patient mortality, and BK virus (p=0.05) as a predictor of graft failure. Fibrosis score was not identify as a predictor of survival.
Conclusion: HCV infection has adverse effect on long-term renal graft and patient survival. Pre-transplant diabetes, deceased donor, prior kidney transplantation, and Knodell score grater than 5 were predictors of patient mortality in this group. Strict selection criteria for KT candidates who are HCV+ may result in better patient and graft survival.
Keywords: Hepatitis C; Kidney transplantation; Outcome
Tuesday, July 25, 2006 12:30 PM
Poster Session: Kidney Transplantation: Clinical / Outcome (12:30 PM-2:00 PM)