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Control of replication of hepatitis B and C virus improves patient and graft survival in kidney transplantation.
Fontaine, Hélène; Alric, Laurent; Labreuche, Julien; Legendre, Benjamin; Louvet, Alexandre; Antoine, Corinne; Legendre, Christophe M; Hazzan, Marc; Kamar, Nassim; Dharancy, Sebastien; Pol, Stanislas; Duhamel, Alain; Mathurin, Philippe.
Afiliação
  • Fontaine H; Unité d'hépatologie, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, INSERM U-1223 et USM20, Institut Pasteur Université Paris Descartes, Paris, France.
  • Alric L; Service de Médecine Interne-Pôle Digestif UMR 152, CHU de Toulouse, France.
  • Labreuche J; Unité de Biostatistiques, France.
  • Legendre B; CHRU de Lille, France, Service des maladies de l'appareil digestif, Université Lille 2 and Inserm U795, France.
  • Louvet A; CHRU de Lille, France, Service des maladies de l'appareil digestif, Université Lille 2 and Inserm U795, France.
  • Antoine C; Agence de la biomédecine, Saint-Denis, France.
  • Legendre CM; Service de Transplantation Rénale Hôpital Necker, Paris, France.
  • Hazzan M; CHRU de Lille, France, Service Néphrologie, Université Lille 2, France.
  • Kamar N; Service Néphrologie Hôpital Purpan, Toulouse, France.
  • Dharancy S; CHRU de Lille, France, Service des maladies de l'appareil digestif, Université Lille 2 and Inserm U795, France.
  • Pol S; Unité d'hépatologie, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, INSERM U-1223 et USM20, Institut Pasteur Université Paris Descartes, Paris, France.
  • Duhamel A; Unité de Biostatistiques, France.
  • Mathurin P; CHRU de Lille, France, Service des maladies de l'appareil digestif, Université Lille 2 and Inserm U795, France. Electronic address: philippe.mathurin@chru-lille.fr.
J Hepatol ; 70(5): 831-838, 2019 05.
Article em En | MEDLINE | ID: mdl-30879789
ABSTRACT
BACKGROUND &

AIMS:

Before antiviral therapy, kidney transplant recipients infected with hepatitis B virus (HBV) or hepatitis C virus (HCV) had poor outcomes. Since the 90s, nucleos(t)ide analogues have been widely used in HBV-infected patients, while interferon-based therapy was rarely used in HCV-infected patients. The aim of this study was to assess the impact of HBV and HCV on patient and graft survival, according to viral replication status.

METHODS:

Data from January 1993 to December 2010 were extracted from the French national database CRISTAL. A total of 31,433 kidney transplant recipients were included, of whom 575, 1,060 and 29,798 had chronic hepatitis B, C, or were not infected, respectively.

RESULTS:

Ten-year survival was lower in HCV-infected (71.3%) than in HBV-infected (81.2%, p = 0.0004) or non-infected kidney transplant recipients (82.7%, p <0.0001). Ten-year kidney graft survival was lower in HCV-infected (50.6%) than in HBV-infected (62.3%, p <0.0001) or non-infected kidney transplant recipients (64.7%, p <0.0001). A random analysis of the medical records of 184 patients with HBV and 504 patients with HCV showed a control of viral replication in 94% and 35% of cases, respectively. Ten-year patient and graft survival in patients with detectable HCV RNA was lower than in their matching controls. Conversely, patients with HCV and undetectable HCV RNA had higher 10-year survival than their matched controls without significant differences in graft survival.

CONCLUSIONS:

Chronic HBV infection does not impact 10-year patient and kidney graft survival thanks to control of viral replication with nucleos(t)ide analogues. In kidney transplant recipients infected with HCV, patients with detectable RNA had worse outcomes, whereas the outcomes of those with undetectable RNA were at least as good as non-infected patients. Thus, direct-acting antivirals should be systematically offered to HCV-infected patients. LAY

SUMMARY:

Previously, infections with hepatitis B or hepatitis C virus led to poor outcomes in kidney transplant recipients. However, the outcomes of kidney transplants in patients with viral suppression are as good as those for kidney transplants in non-infected patients. Antiviral therapy should be systematically proposed to hepatitis B and/or hepatitis C-infected kidney transplant recipients or candidates to prevent the deleterious hepatic and extrahepatic impact of chronic viral replication. Recent access to direct-acting antivirals in patients with hepatitis C virus and renal dysfunction provides exciting new opportunities.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Replicação Viral / Transplante de Rim / Hepatite B Crônica / Hepatite C Crônica / Sobrevivência de Enxerto Tipo de estudo: Observational_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Replicação Viral / Transplante de Rim / Hepatite B Crônica / Hepatite C Crônica / Sobrevivência de Enxerto Tipo de estudo: Observational_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2019 Tipo de documento: Article