Hepatitis C Virus Antibody Status and Survival After Renal Transplantation: Meta-Analysis of Observational Studies

Abstract

The natural history of hepatitis C virus (HCV) among patients after renal transplantation (RT) remains incompletely defined. We conducted a systematic review of the published medical literature on the impact of hepatitis C antibody status on survival of patients who received RT. We used the random effects model of DerSimonian and Laird to generate a summary estimate of the relative risk (RR) for mortality and graft loss with HCV seropositivity across the published studies.We identified eight clinical trials (6365 unique patients); six (75%) were cohort studies and two (2/8 = 25%) controlled trials, respectively. Pooling of study results demonstrated that presence of anti-HCV antibody was an independent and significant risk factor for death and graft failure after RT; the summary estimate for RR was 1.79 (95% CI, 1.57-2.03; homogeneity test, p = 0.0427) and 1.56 (95% CI, 1.35-1.80; homogeneity test, p = 0.0192), respectively. As a cause of death, hepatocellular carcinoma (HCC) and liver cirrhosis were significantly more frequent among anti-HCV positive than anti-HCV negative RT patients.This meta-analysis demonstrates that RT recipients with anti-HCV antibody have an increased risk of mortality and graft failure compared with HCV antibody negative patients.

Development of Novel Combination Therapies

“…Compared to non-HCV-infected CKD Stage 4/5 patients, HCV-infected CKD Stage 4/5 patients have poor graft survival and higher overall mortality outcomes following renal transplantation (Fabrizi, Martin, et al 2005;Terrault and Adey 2007).…”

Seroprevalance of the Hepatitis B and C in Patients with Chronic Kidney Disease without History of Renal Replacement Therapy

“…Increase in the prevalence of CKD, and high rates of HBsAg and Anti-HCV seropositivity seen in hemodialysis patients have rendered these infections important in CKD population. It is known that, in CKD, especially in patients receiving dialysis, and in renal transplant patients, HBV and HCV infections are independent causes of morbidity and mortality (17)(18)(19)(20)(21). The risk of the development of cirrhosis and hepatocellular carcinoma due to chronic HBV and HCV infections, the risk of transmission to the other patients and medical personnel in hemodialysis centers, and the necessity for close follow up in renal transplant patients during immunosuppressive treatment are the major problems associated with HBV and HCV infections.…”

“…Considering that hemodialysis treatment is preferred at the rate of 87.3% while initiating RRT in our country, it can be proposed that the increased Anti-HCV seropositivity in hemodialysis patients compared to CKD patients without RRT may be associated with the hemodialysis modality. (19,20). In addition, it is known that, HCV infection occurs more commonly in CKD and is associated with an increase in the risk of end stage renal disease (15,22).…”

Effect of conversion from calcineurin inhibitors to everolimus on hepatitis C viremia in adult kidney transplant recipients

“…Some studies report a lower patient survival rate of HCVpositive kidney recipients in comparison to HCVnegative recipients, whereas other studies report similar outcomes between these two groups. 3,4 There is a four-to seven-fold increase in HCV viremia after transplantation when compared to the pretransplant period. It has been suggested that the spectrum of immune response to the virus in immunosuppressed patients is as variable as in immunocompetent patients.…”