EFFECT OF HEPATITIS-C INFECTION AND RENAL-TRANSPLANTATION ON SURVIVALIN END-STAGE RENAL-DISEASE

Hepatitis C virus (HCV) infection is common among patients with end-st age renal disease (ESRD). However. the effect of HCV infection on surv ival among ESRD patients, and the impact of renal transplantation on t he course of HCV infection has not been adequately defined. Sera from patients on the renal transplant waiting list at the New England Organ Bank between November 1986 and June 1990 were tested for anti-HCV usi ng a third generation ELISA, All anti-HCV positive patients and a 1:1 ratio of randomly selected anti-HCV negative patients comprised the st udy sample. Duration of follow-up was calculated from the date of the first available serum specimen until death. loss to follow-up or Decem ber 31, 1995, whichever occurred earlier. Multivariate analysis of ris k factors fur mortality was performed using a Cox proportional hazards model which included anti-HCV as a time-independent (baseline) variab le, transplantation as a time-dependent (follow-up) variable. and inde pendently significant baseline covariates. Anti-HCV was detected in 28 7 (1922) of 1544 patients in whom sera were available, and 286 anti-HC V negative patients served as controls. Complete information was avail able in 496 (87%) of these 573 patients. Median follow-up was 73 month s (range 1 to 110 months), during which time 302 (61%) patients underw ent renal transplantation and 154 (31%) patients died. For anti-HCV po sitive patients compared to anti-HCV negative patients, the relative r isk of death land 95% confidence intervals) from all causes was 1.41 ( 1.01 to 1.97) and due to liver disease or infection was 2.39 (1.28 to 4.48). For patients who underwent transplantation compared to those wh o remained on dialysis, the relative risk of death from all causes bet ween 0 to 3 months. 3 to 6 months, seven months to four years, and aft er four years was 4.75 (2.76 to 8.17), 1.76 (0.75 to 4.13), 0.31 (0.18 to 0.54) and 0.84 (0.51 to 1.37), respectively. There was no interact ion between the effect of anti-HCV status at baseline and subsequent t ransplantation (P = 0.93). meaning that the association between treatm ent modality and survival was similar among anti-HCV positive and nega tive patients, at all intervals after transplantation. We conclude tha t HCV infection at the rime of referral for transplantation is associa ted with an increased risk of death, irrespective of whether patients remain on dialysis or undergo transplantation. Transplantation has a b eneficial rather than adverse effect on long-term survival in anti-HCV positive patients. Hence, anti-HCV positive status alone is not a con traindication for renal transplantation.