Different Impacts of Hepatitis B Virus and Hepatitis C Virus on the Outcome of Kidney Transplantation A. Ingsathit, A. Thakkinstian, S. Kantachuvesiri, and V. Sumethkul ABSTRACT Previous studies had shown that HBV and HCV infections lead to increased morbidity and mortality after kidney transplantation when compared with the nonhepatitis group. However, few studies have compared the impact among a population with a high prevalence of HBV and HCV infections. We studied the outcomes of 346 recipients including 23 HBsAg (+) patients (6.6%; group 1), 22 patients with anti-HCV+ (6.3%, group 2), and 301 nonhepatitis patients (group 3) in a single center during a 6-year period. No patient had evidence of precirrhosis or cirrhosis before transplant. The primary end point was graft and patient survival rates. Secondary end point was the rate of progression of chronic allograft, nephropathy. The median follow-up time was 3.7 (0.5– 6.8) years. Five-year actuarial graft survival was 80% for group 1, 61% for group 2, and 88 % for group 3 (P = .005). Cox regression showed HCV (hazards ratio 2.96; 95% CI = 1.03– 8.51) and acute rejection episode (HR 3.01; 95%CI = 1.86 – 4.87) to be significant predictors of graft survival. Actuarial 5-year patient survival of group 1 was significantly lower than group 2 or group 3 (79 % vs 89% and 96%; P = .003). Cox regression revealed that the hazards ratio of HBV for death was 7.63 (95%CI = 1.88 –30.86; P = .004). In contrast, HCV infection had no significant effect on patient survival (HR 1.59; 95%CI = 0.28 –9.02). The rate of chronic allograft nephropathy progression was significantly faster in group 1 (-6.74 mL/min per year) and group 2 (-6.14 mL/min per year) than the controls. We concluded that HBV infection decreased patient survival earlier than HCV and that HCV decreased graft survival more significantly than HBV. Both HBV and HCV were associated with rapid progression of chronic allograft nephropathy. HBV was the strongest risk factor for mortality compared with HCV, with acute rejection episode, with diabetes mellitus, or other hazardous factors. C HRONIC LIVER disease remains a major challenge for kidney transplantation, leading to enhanced morbidity and mortality. 1 The prevalence of HCV infection in recipients ranged between 10% to 41%, and varies among geographical areas. 2–4 The prevalence of HBV infection in most countries is generally lower than that of HCV (1.8% to 3%). 5,6 How- ever, only limited data are available concerning the impact of HBV and HCV in countries with similar prevalence of HCV and HBV in the era of modern immunosuppression. This may be due to the decreased prevalence of HBV infection in several countries. 5 Our study sought to compare the natural impact of HBV and HCV on outcomes among a population with similarly high prevalences of HBV and HCV infections. MATERIALS AND METHODS We examined a cohort of consecutive end-stage renal disease patients who underwent first kidney transplantation at a single- center, university-based hospital during a 6-year study period. All subjects had a follow-up of at least 6 months. All patients were tested for serologic markers of viral hepatitis infection, specifically HBsAg, anti-HBsAb, HBcAg, and anti-HCV. Studied patients had no clinical evidence of precirrhosis or cirrhosis and had negative HBeAg before transplantation. Ultrasonographic examination of the liver was performed in patients who were suspected to have precirrhosis or cirrhosis. Patients who had ultrasonographic evi- dence of cirrhosis or portal hypertension were not included in the study. To determine the natural impact of HBV and HCV on the outcomes, we excluded patients who received antiviral therapy prior to transplantation. Patients were classified as HBV (+) if From the Department of Medicine, Ramathibodi Hospital, Bangkok, Thailand. Address reprint requests to Vasant Sumethkul, MD, Depart- ment of Medicine, Ramathibodi Hospital, 270 Rama 6 Road, Bangkok, Thailand. E-mail: ravsm@mahidol.ac.th 0041-1345/07/$–see front matter © 2007 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2007.02.068 360 Park Avenue South, New York, NY 10010-1710 1424 Transplantation Proceedings, 39, 1424 –1428 (2007)