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

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.