Intermediate-term outcomes of hepatitis C-positive compared with hepatitis C-negative deceased-donor renal allograft recipients

Brown, Kristian L.; El-Amm, Jose M.; Doshi, Mona D.; Singh, Atul; Morawski, Katherina; Cincotta, Elizabeth; Siddiqui, Firdous; Losanoff, Julian E.; West, Miguel S.; Gruber, Scott A.

doi:10.1016/j.amjsurg.2007.12.005

« Previous Next »The American Journal of Surgery
Volume 195, Issue 3 , Pages 298-303, March 2008

Intermediate-term outcomes of hepatitis C-positive compared with hepatitis C-negative deceased-donor renal allograft recipients

Kristian L. Brown, M.D.
- Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
Jose M. El-Amm, M.D.
- Division of Nephrology, Department of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
Mona D. Doshi, M.D.
- Division of Nephrology, Department of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
Atul Singh, M.D.
- Division of Nephrology, Department of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
Katherina Morawski, R.N.
- Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
Elizabeth Cincotta, Pharm.D.
- Department of Pharmacy, Harper University Hospital, Detroit, MI 48201, USA
Firdous Siddiqui, M.D.
- Division of Gastroenterology, Department of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
Julian E. Losanoff, M.D.
- Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
Miguel S. West, M.D., F.A.C.S.
- Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
Scott A. Gruber, M.D., Ph.D., M.B.A., F.A.C.S.
- Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Corresponding author. Tel.: +1-313-745-7319; fax: +1-313-993-0595.

Received 16 November 2007; received in revised form 4 December 2007 published online 15 January 2008.

Abstract

Background

Prior studies have yielded conflicting results concerning the impact of HCV on renal transplant outcomes.

Methods

We examined outcomes in comparable groups of predominantly African American hepatitis C virus (HCV)-positive (n = 34) and HCV-negative (n = 111) kidney transplant patients receiving contemporary immunosupppression.

Results

There was no difference in patient survival or acute rejection, but new-onset diabetes (NODM) was increased and graft survival decreased in the HCV-positive group, with increased graft loss secondary to noncompliance and Type I MPGN. The incidence of NODM among patients undergoing early corticosteroid withdrawal was 11% in both groups, while among those on prednisone, it was 47% in HCV-positive versus 25% in HCV-negative recipients.

Conclusions

Deceased-donor HCV-positive renal allograft recipients have equivalent patient but decreased graft survival. Noncompliance and Type I MPGN play a role in producing this negative effect on graft outcome. Steroids may be required for HCV to exert its diabetogenicity in kidney transplant patients.

Keywords: Hepatitis C, Kidney transplantation, Acute rejection, New-onset diabetes mellitus, Early corticosteroid withdrawal, African American