Hepatitis C antibody status and outcomes in renal transplant recipients

Background. Hepatitis occurs frequently in patients with end-stage renal di sease. In 1997, 0.7% of patients receiving a renal transplant were positive for hepatitis C antibodies. Concern has been raised as to whether these pa tients are at an increased mortality risk after renal transplantation compa red with patients who are hepatitis C antibody negative. To help answer thi s question, we analyzed data from the United States Renal Data System from October of 1988 through June of 1998. Methods. Primary study endpoints were patient death and death censored graf t loss. Secondary study endpoints included cardiovascular, infectious, mali gnant, and infection-related death. Kaplan-Meier survival estimates as well as Cox proportional hazard models were used to evaluate the impact of hepa titis C antibody status on the study endpoints. Results. A total of 73,707 patients were analyzed. Patient survival by Kapl an-Meier analysis was higher in hepatitis C-positive patients, whereas deat h censored graft survival trended lower in the very long term. By the Cox m odel, hepatitis C-positive adjusted patient survival is slightly superior t o that of hepatitis C-negative patients. Conclusions. Renal transplant recipients who are hepatitis C antibody posit ive do not have an increased risk of death after transplantation compared w ith hepatitis C-negative recipients. The current policy of transplanting he patitis C-positive patients without active liver disease seems to incur no excess mortality risk.