Renal Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA.
Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Am J Kidney Dis. 2019 Jun;73(6):815-826. doi: 10.1053/j.ajkd.2018.11.009. Epub 2019 Jan 29.
RATIONALE & OBJECTIVE: Hepatitis C virus (HCV) infection is common among maintenance dialysis patients. Few studies have examined both dialysis survival and transplantation outcomes for HCV-seropositive patients because registry data sets lack information for HCV serostatus.
Retrospective cohort study.
SETTING & PARTICIPANTS: Adult long-term dialysis patients treated by a US national dialysis provider between January 1, 2004, and December 31, 2014.
HCV antibody serostatus obtained as part of clinical data from a national dialysis provider.
Mortality on dialysis therapy, entry onto the kidney transplant waiting list, kidney transplantation, and estimated survival benefit from kidney transplantation versus remaining on the waitlist.
After linking clinical data with data from the Organ Procurement and Transplantation Network, Cox and cause-specific hazards regression were implemented to estimate the associations between HCV seropositivity and mortality, as well as entry onto the kidney transplant waitlist. Cox regression was also used to estimate the survival benefit from transplantation versus dialysis among HCV-seropositive individuals.
Among 442,171 dialysis patients, 31,624 (7.2%) were HCV seropositive. HCV seropositivity was associated with a small elevation in the rate of death (adjusted HR [aHR], 1.09; 95% CI, 1.07-1.11) and a substantially lower rate of entry onto the kidney transplant waitlist (subdistribution HR [sHR], 0.67; 95% CI, 0.61-0.74). Once wait-listed, the kidney transplantation rate was not different for HCV-seropositive (sHR 1.10; 95% CI, 0.96-1.27) versus HCV-seronegative patients. HCV-seropositive patients lived longer with transplantation (aHR at 3 years, 0.42; 95% CI, 0.27-0.63). Receiving an HCV-seropositive donor kidney provided a survival advantage at the 2-year posttransplantation time point compared to remaining on dialysis therapy waiting for an HCV-negative kidney.
No data for HCV viral load or liver biopsy.
HCV-seropositive patients experience reduced access to the kidney transplantation waitlist despite deriving a substantial survival benefit from transplantation. HCV-seropositive patients should consider foregoing HCV treatment while accepting kidneys from HCV-infected donors to facilitate transplantation and prolong survival.
丙型肝炎病毒（HCV）感染在维持性透析患者中很常见。由于登记数据缺乏针对 HCV 血清学状态的信息，因此很少有研究同时检查 HCV 血清阳性患者的透析生存和移植结局。
回顾性队列研究。
2004 年 1 月 1 日至 2014 年 12 月 31 日期间，在美国一家全国性透析机构接受治疗的成年长期透析患者。
从全国性透析机构的临床数据中获得 HCV 抗体血清阳性状态。
透析治疗期间的死亡率、进入肾脏移植等候名单、肾脏移植以及与继续等待相比，从肾脏移植中获得的估计生存获益。
通过将临床数据与器官采购与移植网络的数据进行链接，实施 Cox 和因果风险比回归来估计 HCV 血清阳性与死亡率以及进入肾脏移植等候名单之间的关联。还使用 Cox 回归来估计 HCV 血清阳性个体与透析相比，从移植中获得的生存获益。
在 442171 名透析患者中，有 31624 名（7.2%）为 HCV 血清阳性。HCV 血清阳性与死亡率的轻微升高相关（调整后的 HR [aHR]，1.09；95%CI，1.07-1.11），并且进入肾脏移植等候名单的比率大大降低（亚分布 HR [sHR]，0.67；95%CI，0.61-0.74）。一旦列入等候名单，HCV 血清阳性（sHR，1.10；95%CI，0.96-1.27）与 HCV 血清阴性患者的肾脏移植率无差异。HCV 血清阳性患者在接受移植后寿命更长（aHR 为 3 年，0.42；95%CI，0.27-0.63）。与继续等待接受 HCV 阴性供体肾脏相比，在移植后 2 年时，接受 HCV 血清阳性供体肾脏可提供生存优势。
没有 HCV 病毒载量或肝活检的数据。
尽管 HCV 血清阳性患者从移植中获得了实质性的生存获益，但他们获得肾脏移植等候名单的机会减少。HCV 血清阳性患者在接受 HCV 感染供体的肾脏时应考虑放弃 HCV 治疗，以促进移植并延长生存。
