Hepatitis C virus (HCV) infection is the main cause of chronic liver disease after renal transplantation, which represents a risk factor for graft loss and patient death. Hepatitis C (+) kidney transplant candidates who remain on the waiting list show a greater risk of mortality than those who are transplanted, a risk that escalates with time. The aim of this study was to examine the impact of HCV infection on patient and allograft survival in our transplant population. Among 90 renal transplant patients transplanted between 1991 and 2002 who were retrospectively analyzed, 45 were HCV-positive and 45 HCV-negative by serology. All positive patients had shown positive HCV antibody and/or positive HCV RNA. The mean ages of the patients were 36.2 +/- 9 years among the HCV (+) and 38 +/- 10 years among the HCV (-) patients (P = .31). Eighteen HCV (+) patients and 14 HCV (-) patients received their grafts from deceased donors. The immunosuppressive protocols were similar in both groups. The number of acute rejection episodes were 13 (30%) in HCV (+) and 6 (13%) in the HCV (-) group (P = .006). Diabetes mellitus developed in 10 (23%) HCV (+) and 7 (16%) HCV (-) patients (P = .04). Cytomegalovirus disease occurred in 5 (16%) HCV (+) and 2 (6%) HCV (-) patients (P = .32). The mean serum creatinine was 1.85 +/- 1.1 mg/dL in HCV (+) and 1.8 +/- 1 mg/dL in HCV (-) group (P = .82). The mean graft survivals were 97.1 +/- 52 months in the HCV (+) and 81.1 +/- 37 months in the HCV (-) group (P = .04). Seven HCV (+) patients (16%) and three HCV (-) patients (6%) lost their grafts (P = .04). Advanced cirrhosis developed in three HCV (+) patients (6%). One patient died in the HCV (+) group. Patient survivals were 98% in the HCV (+) and 100% in the HCV (-) cohorts. In this study, the rate of graft loss was higher in HCV (+) patients, whereas the patient survival was similar.