Impact of hepatitis B and C on graft loss and mortality of patients after kidney transplantation

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Abstract
Background: Mortality or graft loss after renal transplantation might be influenced by hepatitis virus infection. Methods: Sera from time of transplantation of 927 renal transplant recipients were tested for hepatitis C (HCV) and hepatitis B virus (HBV) in order to investigate the impact of hepatitis virus infection on graft loss and mortality over an observation period of 20 yr. Results: One hundred and twenty three of 927 patients were HCV positive, 30 patients HBV positive and seven patients HBV and HCV positive. The observation period was 9.2 ± 4.4 yr. Mortality was significantly higher in patients with hepatitis B (p=0.0005), as well as in patients with concomitant B and C hepatitis (p < 0.0001) and in those who acquired HCV infection after transplantation (n=30, p=0.0192) compared with non‐infected patients. Patients with replicating HBV infection (HBeAg positive) had the worst prognosis (p < 0.0001). In the multivariate analysis the presence of HBeAg (p < 0.0001), patients' age (p < 0.0001) and HCV infection after transplantation (p=0.0453) were predictors for death. Graft survival was significantly shorter in patients with concomitant hepatitis B and C (p=0.0087) as well as in HBeAg positive patients (p=0.002). HCV infection or HBs antigenemia did not have a significant impact on graft survival compared with non‐infected patients. Conclusion: HCV infection after transplantation is associated with a high mortality whereas chronic HCV infection before trans plantation does not have a significant impact on mortality. Patients with replicating HBV infection or concomitant HBV and HCV infection have a high risk of graft loss and mortality.