Impact of diabetes and hepatitis after kidney transplantation on patients who are affected by hepatitis C virus

被引:64
作者
Abbott, KC [1 ]
Lentine, KL
Bucci, JR
Agodoa, LY
Koff, JM
Holtzmuller, KC
Schnitzler, MA
机构
[1] Walter Reed Army Med Ctr, Serv Nephrol, Washington, DC 20307 USA
[2] Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA
[3] St Louis Univ, Sch Med, Ctr Outcomes Res, St Louis, MO 63103 USA
[4] NIDDK, Natl Inst Hlth, Bethesda, MD USA
[5] Walter Reed Army Med Ctr, Gastroenterol Serv, Washington, DC 20307 USA
来源
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2004年 / 15卷 / 12期
关键词
D O I
10.1097/01.ASN.0000145439.48387.BF
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Complications associated with use of donor hepatitis C-positive kidneys (DHCV+) have been attributed primarily to posttransplantation liver disease (as a result of hepatitis C disease). The role of posttransplantation diabetes has not been explored in this setting. With the use of the United States Renal Data System database, 28,942 Medicare KT recipients were studied from January 1, 1996, through July 31, 2000. Cox proportional hazards regression models were used to calculate adjusted hazard ratios (AHR) for the association of sero-pairs for HCV (D+/R-, D+/R+, D-/R+ and D-/R-) with Medicare claims for de novo posttransplantation HCV and posttransplantation diabetes. The peak risk for posttransplantation HCV was in the first 6 mo after transplantation. The incidence of posttransplantation HCV after transplantation was 9.1% in D+/R-, 6.3% in D+/R+, 2.4% in D-/R+, and 0.2% in D-/R-. The incidence of posttransplantation diabetes after transplantation also peaked early and was 43.8% in D+/R-, 46.6% in D+/R+, 32.3% in D-/R+, and 25.4% in D-/R-. Associations for both complications were significant in adjusted analysis (Cox regression). Both posttransplantation HCV (AHR, 3.36; 95% confidence interval, 2.44 to 4.61) and posttransplantation diabetes (AHR, 1.81; 95% confidence interval, 1.54 to 2.11) were independently associated with an increased risk of death, but posttransplantation diabetes accounted for more years of life lost, particularly among recipients of DHCV+ kidneys. Posttransplantation diabetes may contribute substantially to the increased risk of death associated with use of DHCV+ kidneys and accounts for more years of life lost than posttransplantation HCV. Because HCV infection acquired after transplantation is so difficult to treat, methods that have been shown to reduce viral transmission warrant renewed attention.
引用
收藏
页码:3166 / 3174
页数:9
相关论文
共 37 条
[1]   Hepatitis C and renal transplantation in the era of modern immunosuppression [J].
Abbott, KC ;
Bucci, JR ;
Matsumoto, CS ;
Swanson, SJ ;
Agodoa, LYC ;
Holtzmuller, KC ;
Cruess, DF ;
Peters, TG .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2003, 14 (11) :2908-2918
[2]   Early renal insufficiency and hospitalized heart disease after renal transplantation in the era of modern immunosuppression [J].
Abbott, KC ;
Yuan, CM ;
Taylor, AJ ;
Cruess, DF ;
Agodoa, LYC .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2003, 14 (09) :2358-2365
[3]   Hospitalizations for cytomegalovirus disease after renal transplantation in the United States [J].
Abbott, KC ;
Hypolite, IO ;
Viola, R ;
Poropatich, RK ;
Hshieh, P ;
Cruess, D ;
Hawkes, CA ;
Agodoa, LY .
ANNALS OF EPIDEMIOLOGY, 2002, 12 (06) :402-409
[4]  
Batty DS, 2001, AM J TRANSPLANT, V1, P179, DOI 10.1034/j.1600-6143.2001.10213.x
[5]   Association of hepatitis C with posttransplant diabetes in renal transplant patients on tacrolimus [J].
Bloom, RD ;
Rao, V ;
Weng, F ;
Grossman, RA ;
Cohen, D ;
Mange, KC .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2002, 13 (05) :1374-1380
[6]   Donor hepatitis C seropositivity: Clinical correlates and effect on early graft and patient survival in adult cadaveric kidney transplantation [J].
Bucci, JR ;
Matsumoto, CS ;
Swanson, SJ ;
Agodoa, LYC ;
Holtzmuller, KC ;
Peters, TG ;
Abbott, KC .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2002, 13 (12) :2974-2982
[7]   Hepatitis C virus-positive patients on the waiting list for transplantation [J].
Campistol, JM ;
Esforzado, N ;
Morales, JM .
SEMINARS IN NEPHROLOGY, 2002, 22 (04) :361-364
[8]   Pretransplant interferon prevents hepatitis C virus-associated glomerulonephritis in renal allografts by HCV-RNA clearance [J].
Cruzado, JM ;
Casanovas-Taltavull, T ;
Torras, J ;
Baliellas, C ;
Gil-Vernet, S ;
Grinyó, JM .
AMERICAN JOURNAL OF TRANSPLANTATION, 2003, 3 (03) :357-360
[9]   Management of chronic viral hepatitis before and after renal transplantation [J].
Gane, E ;
Pilmore, H .
TRANSPLANTATION, 2002, 74 (04) :427-437
[10]   Hepatitis C and the incidence of diabetes mellitus after renal transplant:: Influence of new immunosuppression protocols [J].
Gentil, MA ;
López, M ;
González-Roncero, FG ;
Rodríguez-Algarra, G ;
Pereira, P ;
López, R ;
Martínez, M ;
Toro, J ;
Mateos, J .
TRANSPLANTATION PROCEEDINGS, 2003, 35 (05) :1748-1750