Hepatitis C infection in potential recipients with normal liver biochemistry does not preclude renal transplantation

Abstract

The hepatitis C virus (HCV) may be an important cause of chronic liver disease in renal transplant recipients. We investigated retrospectively the incidence and outcome of HCV infection in long-term renal transplant recipients and patients on hemodialysis. Stored, pretransplant sera of transplant recipients with normal liver biochemistry at surgery were tested for hepatitis C by a second-generation enzyme immunoassay. Hemodialysis patients were tested by a first-generation enzyme-linked immunosorbent assay (ELISA) against c100-3. We studied 252 renal transplant recipients and 58 hemodialysis patients followed for 65 +/- 10 months and 26 +/- 6 months, respectively. Fifteen percent (38/252) of the transplant recipients were HCV positive as were 3/58 (5%) of the hemodialysis patients. Overt liver disease occurred in 22/252 (8.7%) transplant recipients and none in the hemodialysis group. Thirty-six percent (8/22) of transplant recipients with overt liver disease were HCV positive. No HCV-positive patients died of liver failure. Of six biopsies in the HCV-positive transplant group, two had histological evidence of CAH. CAH was seen in six of eight biopsies in the HCV-negative transplants and two of these latter patients progressed to cirrhosis. No hemodialysis patients had clinical or histological evidence of chronic liver disease. Two HCV-negative transplant patients died of liver failure, while no deaths related to liver disease occurred in hemodialysis patients regardless of HCV status. We conclude that hepatitis C may cause chronic hepatitis in renal transplant patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis C Virus Seropositivity at the Time of Renal Transplantation in the United States: Associated Factors and Patient Survival

“…In an American population, Kazi et al. (15) reported a prevalence of HCV seropositivity of 15% in long‐term renal transplant recipients, but 5% in hemodialysis patients, which is in agreement with the findings of the present analysis (i.e. patients at the time of receipt of renal transplantation).…”

Hepatitis C viral infection in the immunosuppressed patient

“…Despite these limitations, the short term, i.e., a 3-to 5-year survival of patients receiving a renal allograft, is similar to those with and without HCV-infection. 24,25 Abnormal liver biochemistry is uncommon following renal transplant in individuals with HCV who had normal liver biochemistry preceding transplantation. In one study only 22% (8 of 38) developed biochemical evidence of chronic hepatitis over a mean follow up of 65 months.…”

“…Of the six who underwent liver biopsy, only two had abnormal histology and none of the deaths within this period of time were due to liver failure. 24 In a prospective study of 23 selected hepatitis C renal transplant recipients without pretransplant evidence of chronic hepatitis (biochemical or histological), 60% developed elevated serum aminotransaminase levels (only 26% chronically elevated) within four years posttransplant, but no liver related mortality was reported. 25 This is in contrast with the publication of Periera et al in which 23 HCV-positive patients, who received a renal transplant, showed a fivefold increased risk of post-transplant liver disease compared with 80 HCV-negative renal transplant recipients.…”

Impact of hepatitis B and C virus on kidney transplantation outcome

“…[15][16][17][18] Now, since the advent of routine HBV vaccination, most hepatic diseases in kidney transplantation are mainly a result of HCV virus infection. 19,20 The most frequent risk factors of contamination usually described are number of transfusions, duration of extra renal assistance, and type of dialysis, especially hemodialysis.…”