Outcomes of hepatitis C-positive kidney transplant recipients compared with hepatitis C-negative recipients in today’s era of immunosuppression: A UNOS database analysis with long-term follow-up

Ali Khalil, Muhammad Mujtaba, Omar T. Aljanabi, Marwan S. Ghabril, Tim E. Taber, Muhammed S. Yaqub, Asif Sharfuddin

Research output: Contribution to journalReview article

Abstract

Objectives: Our objective was to study the outcomes of hepatitis C-positive renal transplant recipients compared with hepatitis C-negative renal transplant recipients. Materials and Methods: We reviewed the outcomes of hepatitis C-positive kidney transplant recipients compared with hepatitis C virus-negative recipients from the United Network for Organ Sharing/Organ Procurement and Transplantation Network database for transplants from 2000 to 2004 with follow-up until 2012. Of 61 775 recipients, 3334 were hepatitis C positive at time of transplant. Results: Hepatitis C-positive recipient status was significantly associated with male gender (70.1% vs 58.6%), deceased donor type (73.9% vs 56.6%), African American race (55.7% vs 26.8%), recipient age, increased duration of pretransplant dialysis (mean 724 days vs 624), previous transplant (19.4% vs 11.5%), donor hepatitis C positivity, delayed graft function (23.9% vs 16.0%), and all-cause hospitalizations. All-cause unadjusted, death-censored graft survival and patient survival were all significantly lower in hepatitis C-positive recipients (P <.0001). One-year acute rejection rates were higher in the hepatitis C-positive group (17.2% vs 14.6%; P =.001). Within the hepatitis C-positive group, graft survival was inferior for those who received a hepatitis C-positive donor kidney compared with a hepatitis C-negative donor kidney and those who received a deceased-donor kidney as compared with a living-donor kidney. In multivariate and Cox regression analyses, the adjusted hazard ratio for graft failure for hepatitis C positive was 1.34 (P <.001, 95% confidence interval, 1.31-1.37). Conclusions: Even in today’s era, this updated analysis still shows major inferior outcomes in hepatitis C-positive transplant recipients. Hence, aggressive treatment for hepatitis C before and after should be considered.

Original languageEnglish (US)
Pages (from-to)282-288
Number of pages7
JournalExperimental and Clinical Transplantation
Volume15
Issue number3
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

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Hepatitis C
Immunosuppression
Databases
Kidney
Tissue Donors
Transplants
Graft Survival
Transplant Recipients
Delayed Graft Function
Tissue and Organ Procurement
Living Donors
Organ Transplantation
Hepacivirus
African Americans
Dialysis
Cause of Death
Hospitalization
Regression Analysis

Keywords

  • Graft survival
  • Hepatitis C
  • Kidney transplant

ASJC Scopus subject areas

  • Transplantation

Cite this

Outcomes of hepatitis C-positive kidney transplant recipients compared with hepatitis C-negative recipients in today’s era of immunosuppression : A UNOS database analysis with long-term follow-up. / Khalil, Ali; Mujtaba, Muhammad; Aljanabi, Omar T.; Ghabril, Marwan S.; Taber, Tim E.; Yaqub, Muhammed S.; Sharfuddin, Asif.

In: Experimental and Clinical Transplantation, Vol. 15, No. 3, 01.06.2017, p. 282-288.

Research output: Contribution to journalReview article

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title = "Outcomes of hepatitis C-positive kidney transplant recipients compared with hepatitis C-negative recipients in today’s era of immunosuppression: A UNOS database analysis with long-term follow-up",
abstract = "Objectives: Our objective was to study the outcomes of hepatitis C-positive renal transplant recipients compared with hepatitis C-negative renal transplant recipients. Materials and Methods: We reviewed the outcomes of hepatitis C-positive kidney transplant recipients compared with hepatitis C virus-negative recipients from the United Network for Organ Sharing/Organ Procurement and Transplantation Network database for transplants from 2000 to 2004 with follow-up until 2012. Of 61 775 recipients, 3334 were hepatitis C positive at time of transplant. Results: Hepatitis C-positive recipient status was significantly associated with male gender (70.1{\%} vs 58.6{\%}), deceased donor type (73.9{\%} vs 56.6{\%}), African American race (55.7{\%} vs 26.8{\%}), recipient age, increased duration of pretransplant dialysis (mean 724 days vs 624), previous transplant (19.4{\%} vs 11.5{\%}), donor hepatitis C positivity, delayed graft function (23.9{\%} vs 16.0{\%}), and all-cause hospitalizations. All-cause unadjusted, death-censored graft survival and patient survival were all significantly lower in hepatitis C-positive recipients (P <.0001). One-year acute rejection rates were higher in the hepatitis C-positive group (17.2{\%} vs 14.6{\%}; P =.001). Within the hepatitis C-positive group, graft survival was inferior for those who received a hepatitis C-positive donor kidney compared with a hepatitis C-negative donor kidney and those who received a deceased-donor kidney as compared with a living-donor kidney. In multivariate and Cox regression analyses, the adjusted hazard ratio for graft failure for hepatitis C positive was 1.34 (P <.001, 95{\%} confidence interval, 1.31-1.37). Conclusions: Even in today’s era, this updated analysis still shows major inferior outcomes in hepatitis C-positive transplant recipients. Hence, aggressive treatment for hepatitis C before and after should be considered.",
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T1 - Outcomes of hepatitis C-positive kidney transplant recipients compared with hepatitis C-negative recipients in today’s era of immunosuppression

T2 - A UNOS database analysis with long-term follow-up

AU - Khalil, Ali

AU - Mujtaba, Muhammad

AU - Aljanabi, Omar T.

AU - Ghabril, Marwan S.

AU - Taber, Tim E.

AU - Yaqub, Muhammed S.

AU - Sharfuddin, Asif

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N2 - Objectives: Our objective was to study the outcomes of hepatitis C-positive renal transplant recipients compared with hepatitis C-negative renal transplant recipients. Materials and Methods: We reviewed the outcomes of hepatitis C-positive kidney transplant recipients compared with hepatitis C virus-negative recipients from the United Network for Organ Sharing/Organ Procurement and Transplantation Network database for transplants from 2000 to 2004 with follow-up until 2012. Of 61 775 recipients, 3334 were hepatitis C positive at time of transplant. Results: Hepatitis C-positive recipient status was significantly associated with male gender (70.1% vs 58.6%), deceased donor type (73.9% vs 56.6%), African American race (55.7% vs 26.8%), recipient age, increased duration of pretransplant dialysis (mean 724 days vs 624), previous transplant (19.4% vs 11.5%), donor hepatitis C positivity, delayed graft function (23.9% vs 16.0%), and all-cause hospitalizations. All-cause unadjusted, death-censored graft survival and patient survival were all significantly lower in hepatitis C-positive recipients (P <.0001). One-year acute rejection rates were higher in the hepatitis C-positive group (17.2% vs 14.6%; P =.001). Within the hepatitis C-positive group, graft survival was inferior for those who received a hepatitis C-positive donor kidney compared with a hepatitis C-negative donor kidney and those who received a deceased-donor kidney as compared with a living-donor kidney. In multivariate and Cox regression analyses, the adjusted hazard ratio for graft failure for hepatitis C positive was 1.34 (P <.001, 95% confidence interval, 1.31-1.37). Conclusions: Even in today’s era, this updated analysis still shows major inferior outcomes in hepatitis C-positive transplant recipients. Hence, aggressive treatment for hepatitis C before and after should be considered.

AB - Objectives: Our objective was to study the outcomes of hepatitis C-positive renal transplant recipients compared with hepatitis C-negative renal transplant recipients. Materials and Methods: We reviewed the outcomes of hepatitis C-positive kidney transplant recipients compared with hepatitis C virus-negative recipients from the United Network for Organ Sharing/Organ Procurement and Transplantation Network database for transplants from 2000 to 2004 with follow-up until 2012. Of 61 775 recipients, 3334 were hepatitis C positive at time of transplant. Results: Hepatitis C-positive recipient status was significantly associated with male gender (70.1% vs 58.6%), deceased donor type (73.9% vs 56.6%), African American race (55.7% vs 26.8%), recipient age, increased duration of pretransplant dialysis (mean 724 days vs 624), previous transplant (19.4% vs 11.5%), donor hepatitis C positivity, delayed graft function (23.9% vs 16.0%), and all-cause hospitalizations. All-cause unadjusted, death-censored graft survival and patient survival were all significantly lower in hepatitis C-positive recipients (P <.0001). One-year acute rejection rates were higher in the hepatitis C-positive group (17.2% vs 14.6%; P =.001). Within the hepatitis C-positive group, graft survival was inferior for those who received a hepatitis C-positive donor kidney compared with a hepatitis C-negative donor kidney and those who received a deceased-donor kidney as compared with a living-donor kidney. In multivariate and Cox regression analyses, the adjusted hazard ratio for graft failure for hepatitis C positive was 1.34 (P <.001, 95% confidence interval, 1.31-1.37). Conclusions: Even in today’s era, this updated analysis still shows major inferior outcomes in hepatitis C-positive transplant recipients. Hence, aggressive treatment for hepatitis C before and after should be considered.

KW - Graft survival

KW - Hepatitis C

KW - Kidney transplant

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