HEPATITIS-C IS A POOR PROGNOSTIC INDICATOR IN BLACK KIDNEY-TRANSPLANTRECIPIENTS

Background. The significance of hepatitis C in kidney transplant recip ients is unclear. The prevalence of antibodies to hepatitis C among ca ndidates for transplantation is up to 50% in some centers. Methods. We screened 640 frozen serum samples obtained pretransplantation from al l kidney recipients at the Medical College of Wisconsin between Januar y 1979 and March 1990 for antibody to hepatitis C using the second gen eration immunoassay. Charts were reviewed from all hepatitis C antibod y-positive (anti-HCV+) patients and 256 randomly chosen hepatitis C an tibody negative (anti-HCV-) controls. Actuarial patient and graft surv ival in these two groups were determined. Results. The prevalence of a nti-HCV was 8.3%. Blacks and i.v. drug users were disproportionately r epresented in the anti-HCV+ group. Of the anti-HCV+ patients, 18.9% de veloped chronic hepatitis independent of race. Black anti-HCV+ patient s had a 5-year graft survival of 28+/-11% compared to 67+/-7% in black anti-HCV-patients (P=0.003). Black anti-HCV-, white anti-HCV-, and wh ite anti-HCV+ patients all had similar graft survival. Anti-HCV was no t a poor prognostic indicator for overall patient survival or the deve lopment of aplastic anemia and malignancies including hepatocellular c arcinoma. Conclusions. Anti-HCV is a significant risk factor for reduc ed kidney graft survival in blacks apart from i.v. drug abuse. Black a nti-HCV- patients had graft survival similar to white transplant recip ients, indicating that anti-HCV may be one marker for the poorer graft survival in blacks that has been observed in most transplant programs . Anti-HCV in kidney transplant recipients increases the risk for the development of chronic hepatitis post-transplant.