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Jul/Aug/Sep 2013; 2(3)

Racial Disparities in Post-Transplant Survival Among Renal Transplant Recipients with Pre-Transplant Hepatitis C Seropositivity

Palaniappan Manickam, Rajesh Krishnamoorthi, Lakshminarayanan Nandagopal, Anurag Mehrotra, Arun Kumar Muthusamy, Zeenat Bhat

+Author Affiliations

Palaniappan Manickam

Division of Gastroenterology, Oakland University William Beaumont School of Medicine, Michigan, United States

Rajesh Krishnamoorthi

Department of Internal Medicine, Wayne State University, Michigan, United States

Lakshminarayanan Nandagopal

Department of Internal Medicine, Wayne State University, Michigan, United States

Anurag Mehrotra

Department of Internal Medicine, Wayne State University, Michigan, United States

Arun Kumar Muthusamy

Department of Internal Medicine, Wayne State University, Michigan, United States

Zeenat Bhat

Division of Nephrology, Wayne State University, Michigan, United States

Corresponding Author:

Palaniappan Manickam, Palaniappan.Manickam@beaumont.edu

Abstract

Background & Aims: Substantial epidemiological evidence exists for a relationship between Hepatitis C virus (HCV) seropositivity and adverse outcomes among renal transplant (RT) recipients. However, data on whether gender or ethnicity modulates this association is relatively scarce.
Methods: We did a post-hoc analysis of the limited access dataset of United Network for Organ Sharing/ Organ Procurement and Transplantation Network. All adult RT recipients with complete details on the HCV serostatus and follow-up (n=169,261) were included in the analysis. All simultaneous transplants were excluded. Univariate analysis was done to determine the significant predictors of survival. Cox proportional hazards model was used to adjust for significant risk predictors.
Results: A total of 169,261 patients were included in the analysis. Mean age was 48±13 years. There were 10,238 HCV seropositive recipients, of which 2192 (21.5%) died over a mean follow up of 4 yrs. In the multivariate analysis, HCV seropositivity was independently associated with post-transplant survival in the overall cohort. Among HCV patients, when compared to African-Americans, Caucasians were at increased risk of all-cause mortality (HR: 1.18, 95% CI: 1.06 to 1.31; p=0.002). However, there were no statistically significant differences in overall survival in HCV positive patients among other races.
Conclusions: Our study identifies a possible racial difference in all-cause mortality among HCV seropositive renal transplant recipients. This could possibly be explained by the difference in immunologic response among different races. The impact of viral eradication in this population has to be quantified by further research.

Received January 13, 2013.

Revised March 30, 2013.

Accepted April 15, 2013.

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Published September 20, 2013;

DOI:10.7178/ig.36

Immunogastroenterology

2013;2(3): 173-176.

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