Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA.
Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea.
Transplantation. 2018 Mar;102(3):454-460. doi: 10.1097/TP.0000000000001953.
Hepatitis C virus (HCV) infection is common among kidney transplant (KTx) recipients. However, the impact of HCV infection on long-term graft and recipient survival after KTx from large-scale data remains to be determined.
We used the Organ Procurement and Transplantation Network database to identify all adults undergoing KTx in 2004 to 2006 in the United States. A propensity score was created to match each HCV-positive recipient with an HCV-negative control for unbiased comparisons. Survival analysis was conducted to evaluate recipient and death-censored graft survival.
Out of 33 357 adult primary KTx recipients, 1470 (4.4%) were HCV-positive: 1364 HCV-positive and -negative pairs were selected by propensity score matching. Based on multivariable regression models, HCV is associated with a higher risk of death (hazard ratio [HR], 1.50; 95% confidence interval [95% CI], 1.28-1.75) and graft failure (HR, 1.26; 95% CI, 1.08-1.47). Infection was a more common cause of death in HCV-positive patients than in HCV-negative recipients (HR, 1.64; 95% CI, 1.12-2.42). The incidence of death due to liver failure was 0.23% per year among HCV-positive recipients, whereas no HCV-negative recipients died from liver failure. Graft failure due to recurrent disease was higher in HCV-positive than in HCV-negative recipients (HR, 2.00; 95% CI, 1.06-3.78).
HCV infection is associated with decreased long-term recipient and graft survival. Future studies are needed to examine whether recently available, safe, and effective antiviral therapy improves the long-term clinical outcome in these patients.
丙型肝炎病毒（HCV）感染在肾移植（KTx）受者中很常见。然而，从大规模数据来看，HCV 感染对 KTx 后长期移植物和受者生存的影响仍有待确定。
我们使用器官获取和移植网络数据库，确定了 2004 年至 2006 年期间在美国接受 KTx 的所有成年人。创建了倾向评分，以对每例 HCV 阳性受者与 HCV 阴性对照进行匹配，以进行无偏比较。进行生存分析以评估受者和死亡删失移植物的生存情况。
在 33357 例成人原发性 KTx 受者中，1470 例（4.4%）为 HCV 阳性：通过倾向评分匹配选择了 1364 对 HCV 阳性和阴性的受者。基于多变量回归模型，HCV 与较高的死亡风险相关（危险比[HR]，1.50；95%置信区间[95%CI]，1.28-1.75）和移植物失败（HR，1.26；95%CI，1.08-1.47）。HCV 阳性患者的感染是死亡的更常见原因，而 HCV 阴性受者则不是（HR，1.64；95%CI，1.12-2.42）。HCV 阳性受者因肝功能衰竭导致死亡的发生率为每年 0.23%，而无 HCV 阴性受者因肝功能衰竭而死亡。HCV 阳性受者因疾病复发导致移植物失败的比例高于 HCV 阴性受者（HR，2.00；95%CI，1.06-3.78）。
HCV 感染与受者和移植物的长期生存率降低有关。需要进一步研究，以评估最近可用的、安全有效的抗病毒治疗是否能改善这些患者的长期临床结局。
