Effect of hepatitis C infection on long-term graft functions in kidney transplant patients

Introduction and Objective: Our study aimed to evaluate the effect of HCV positivity on long-term graft functions and other clinical parameters in kidney transplant recipients. Materials and methods: The study included 531 individuals (HCV+: 135 patients) who underwent kidney transplantation at Akdeniz University Faculty of Medicine Organ Transplantation Center between 1989 and 2023. Demographic, clinical, biochemical, serological, and therapeutic data were evaluated. Liver failure, chronic liver disease, cirrhosis development, graft, and patient survival rates, causes of graft loss, chronic allograft dysfunction rates, rejection rates, post-transplant tumor development rates, post-transplant DM development rates, albumin levels, graft functions and proteinuria levels, CMV, BKV, and COVID viremia were compared between HCV positive and negative patients. Data were collected retrospectively and analyses were performed using the SPSS 23.0 program. Results: The mean follow-up times after transplantation in HCV-positive and negative patients were 166 (0-148) months and 72 (0-386) months, respectively (p<0.001). The acute rejection rate was similar between the groups (p:0.740). No significant difference was found between the two groups in the 2nd acute rejection rate (p:0.382). The delayed graft function rate was significantly higher in HCV-positive patients (p:0.049). Postoperative dialysis requirement was detected in 26 (6.6%) HCV-negative patients and 17 (12.6%) HCV-positive patients (p:0.027). Chronic allograft dysfunction developed in 19 (4.8%) HCV-negative patients and 5 (3.7%) HCV-positive patients (p:0.597). 31.1% of HCV-positive patients and 13.1% of HCV-negative patients died during the follow-up period, and the mortality rate was significantly higher in HCV-positive patients (p<0.001). This was thought to be related to the longer follow-up period. New-onset diabetes mellitus after transplantation was found to be significantly higher in the HCV-negative group (p<0.001). This was thought to be due to high tacrolimus use rates and other diabetogenic factors. The rate of CMV viremia was found to be high in HCV-positive patients (p:0.007), while the rates of BK virus nephropathy and COVID-19 infection (p:0.043) were lower (p:0.006). The rate of acute hepatitis after transplantation was significantly higher in HCV-positive patients (p<0.001). Cirrhosis developed in 1 (0.7%) patient in the HCV-positive group. Liver failure or hepatorenal syndrome did not develop in either patient group after transplantation. There was no significant difference in graft function and proteinuria between the groups except for the last control. The difference in the previous control was thought to be related to the longer follow-up period in HCV-positive patients. Graft and patient survival rates were also similar between the groups (p: 0.365, p: 0.672, respectively). Conclusion: Our study has shown that HCV infection in kidney transplant patients does not negatively affect patient and graft survival and that kidney transplantation is a safe and effective method of renal replacement therapy in HCV-positive end-stage renal disease patients.