Impact of hepatitis C virus status in pancreas transplantation: A case controlled study

Available data suggest that hepatitis C virus positive (HCV⁺) renal transplant patients may be at an increased risk of morbidity and mortality compared with HCV^- patients. Limited data are available regarding the impact of HCV status in pancreas transplant patients. We compared the outcomes of 10 HCV⁺ patients undergoing pancreas transplantation (seven simultaneous kidney-pancreas, one pancreas after kidney, two pancreas alone) between 1/96 and 10/99 with 20 HCV^- recipients that were matched for age, race, gender, timing of transplant, type of pancreas transplant, and surgical technique. Length of follow-up was not significantly different between the HCV⁺ group compared with the HCV^- group (24 ± 14 vs. 20 ± 13 months; p = 0.45). There was a trend toward a higher incidence of all cause mortality in HCV⁺ recipients compared with HCV^- recipients, 30 vs. 10%, respectively (p = 0.17). Additionally, the HCV⁺ recipients had a trend toward a higher incidence of sepsis-related mortality compared with HCV^- recipients, 20 vs. 5%, respectively (p = 0.19). Renal allograft survival was 50% in the HCV⁺ group compared with 94% in the HCV^- group . (p = 0.02). Pancreas allograft survival was not significantly different between the groups, 60 vs. 80%, respectively (p = 0.24). At 3, 6, 12 months, and end of follow-up, there were no differences in serum creatinine, amylase, C-peptide, or fasting glucose levels. However, there was a significantly higher incidence of proteinuria at last follow-up in the HCV⁺ recipients with a renal allograft when compared with HCV^- recipients, 50 vs. 12.5%, respectively (p = 0.05). In order to maintain comparable glycemic control between the groups, there was a significant increase in oral hypoglycemic requirement in HCV⁺ recipients compared with HCV^- recipients, 33 vs. 0%, respectively (p = 0.01). These data suggest that HCV⁺ pancreas transplant patients may be at an increased risk of graft dysfunction and morbidity. Further studies with more patients and longer follow-up are needed to fully define the impact of HCV status on pancreas graft survival and function.