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Outcome of Hepatitis C Virus‐Infected Kidney Transplant Candidates Who Remain on the Waiting List
Author(s) -
Bloom Roy D.,
Sayer Gabriel,
Fa Kosunarty,
Constantinescu Serban,
Abt Peter,
Reddy K. Rajender
Publication year - 2005
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2004.00652.x
Subject(s) - medicine , retrospective cohort study , diabetes mellitus , cohort , hepatitis c , hepatitis c virus , kidney transplantation , liver disease , kidney disease , proportional hazards model , transplantation , cohort study , liver transplantation , renal replacement therapy , gastroenterology , immunology , virus , endocrinology
The management of patients awaiting transplantation is a growing concern. This retrospective cohort study examined outcomes of hepatitis C virus (HCV)‐infected kidney candidates who remain waitlisted. Records from 315 HCV+ kidney candidates evaluated between 1992 and 2002, were reviewed. A total of 300 (95.1%) patients were receiving renal replacement therapy at evaluation, median duration 48.2 + 4.3 months. The diabetes prevalence was 42.9% in HCV+ candidates, compared to 35.9% among 602 currently listed HCV− patients (p = 0.023). Liver disease, defined by abnormal hepatic biochemistry or histology, was observed in 59% patients. Median post‐evaluation follow‐up was 1440 ± 75 days; 138 candidates were transplanted. Kaplan–Meier survival was higher among transplanted than non‐transplanted patients (p = 0.003). Of 177 patients not transplanted, 76 were delisted, mostly due to death (45%) and non‐compliance (28%), infrequently because of liver disease (8.8%). A Cox regression model was fit to examine risk factors for waitlist death; only diabetes was associated (HR: 2.17, 95% CI: 1.1–4.1, p = 0.02), while liver disease was not. This study demonstrates that, in waitlisted HCV+ kidney patients, diabetes occurs with increased prevalence and is a major mortality determinant. Diabetic HCV+ kidney candidates are therefore a patient subgroup that requires frequent and careful reevaluation to ensure ongoing transplantability.