Long-term follow-up of hepatitis C virus infection among organ transplant recipients: implications for policies on organ procurement.

BACKGROUND

Hepatitis C virus (HCV) infection causes slowly progressive liver disease. Therefore, the full impact of HCV infection after transplantation may require 5-10 years of follow-up.

METHODS

We have previously reported the effect of HCV infection, acquired from the donor (study 1) or acquired before transplantation (study 2), on the incidence of liver disease, and on patient and graft survival with a median follow-up of 3-5 years. In study 1, we compared 24 recipients of organs from donors who were positive to antibody to HCV (anti-HCV) to 74 recipients of organs from anti-HCV-negative donors. In study 2, we compared 23 anti-HCV-positive recipients to 80 anti-HCV-negative recipients of kidneys from anti-HCV-negative donors. In this report, we extend the median follow-up period for patient and graft survival to 6-7 years, and discuss the implications of our finding on policies for organ procurement.

RESULTS

In study 2, after extended follow-up, there continued to be no significant difference between groups with respect to graft loss, but mortality remained significantly higher among recipients with anti-HCV before transplantation. Compared with recipients without anti-HCV before transplantation, the relative risk of graft loss among recipients with anti-HCV before transplantation was 1.30 (0.66-2.58), the relative risk of death was 2.60 (1.15-5.90), and the relative risk of death due to sepsis was 6.30 (1.99-20). In study 1, after extended follow-up, there continued to be no significant differences between groups, with respect to graft loss or death. Compared with recipients of organs from anti-HCV-negative donors, the relative risk of graft loss among recipients of organs from anti-HCV-positive donors was 0.95 (0.54-1.67), and the relative risk of death was 1.00 (0.49-2.02).

CONCLUSIONS

The two studies presented in this report provide an apparent paradox, with respect to the impact of HCV infection acquired at the time of transplantation versus before transplantation on posttransplantation clinical outcomes. However, the increased mortality among recipients who acquired HCV infection before transplantation, but not among recipients who acquired HCV at the time of transplantation, could be explained by the longer duration of HCV infection in the former group. These findings are consistent with the known slowly progressive nature of HCV infection. However, in the absence of definitive evidence for an adverse effect on patient or graft survival, we believe that the decision to accept a kidney from an anti-HCV-positive donor should be made by the patient, after discussion with the treating physician.