Transmission of Hepatitis C Virus by Organ Transplantation

Pereira, Brian J.G.; Milford, Edgar L.; Kirkman, Robert L.; Levey, Andrew S.

doi:10.1056/nejm199108153250702

Cited by 350 publications

(109 citation statements)

References 34 publications

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“…The initial report of Laquaglia et al [16] found marked extrahepatic infections in hepatitis-positive post-transplant patients. A higher incidence of infection and death due to sepsis was also reported by Periera et al [4] and recently by Rao and Ma [17,] who found a higher incidence of infection in HCV-positive patients as compared to the HCV-negative counterparts. In the present study, the number of patients who developed diabetes in the presence of immunosuppressive medication (cyclosporine and prednisolone) were found more in HCV-positive patients than in HCV-negative patients.…”

Section: Discussionsupporting

confidence: 49%

“…Pereira et al [4] found a relatively higher risk of graft loss, death and sepsis in HCV-positive transplant patients than HCV-negative patients. In line with this report, the present study established a higher incidence of graft failure and fatal infections (table 3).…”

Section: Discussionmentioning

confidence: 99%

“…Most common causative agents are hepatitis C virus (HCV) and hepatitis B virus (HBV) [2, 3]. Chronic renal failure patients could acquire hepatitis C infection from blood transfusion, hemodialysis or an infected renal graft [4]. This point is of special significance as these viral infections have profound implications for patient’s health and graft survival.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Chronic Viral Hepatitis on Graft Survival in Saudi Renal Transplant Patients

Mitwalli¹,

Alam

Al-Wakeel³

et al. 2005

Nephron Clin Pract

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Background: In Saudi Arabia the prevalence of hepatitis C among hemodialysis patients is very high ranging from 60 to 80%. A large number of these dialysis patients go for renal transplant, resulting into a higher prevalence of hepatitis C virus (HCV) infection in renal transplant patients. Yet no current systematic report is available on the influence of hepatitis C status on patient and graft survival. The present study was therefore undertaken to address this objective. Methods: Retrospective analysis of data of 448 renal transplantation subjects was undertaken. The mean follow-up period was 5.85 ± 2.7 (median 5.3) years. The factors associated with renal graft survival were reviewed and these include: age, sex, and type of donor, immunosuppressive medication, episodes of infection, blood pressure, serum creatinine, and status of hepatitis. The primary end-points were renal graft function and patient survival. Logistic regression, COX regression analysis, and Kaplan-Meier survival estimates were used to evaluate the influence of hepatitis C on the above parameters. Results: Among 448 recipients of first kidney transplant patients, 286 (63.8%) were positive for HCV infection. In the HCV-positive group, 204 (71.32%) were males. Kaplan-Meier survival analysis showed a significantly better graft survival for HCV-negative patients than HCV-positive patients (p < 0.001; log-rank test). Logistic regression analysis and COX regression analysis have shown different grades of graft dysfunction were present in HCV-positive patients after adjustment for covariates: age, sex, blood pressure, type of donor, and immunosuppressive medication; the presence of HCV was a major predictor of bad outcome and significantly influenced graft survival (odds ratio = 4.37; 95% Cl = 1.81–4.77). Significant deterioration of liver function was noted in HCV-positive patients at the last follow-up, taking ALT as a marker (ALT level 80.6 ± 5.8 U/l at the last follow-up versus 49.5 ± 32 U/l at baseline p ≤ 0.0001). Sixteen patients had a chronic active course and 1 patient developed biopsy-proven liver cirrhosis and portal hypertension. A serious and significantly greater incidence of fatal chest infections was seen in HCV-positive patients. Although mortality was greater in HCV-positive versus HCV-negative patients (20 vs. 7), the difference did not attain statistical significance (p = 0.23) and none of the patients died as a result of hepatic failure. Conclusion: The presence of HCV infection greatly influenced graft survival in renal transplant patients and a higher proportion of infected patients had renal and hepatic dysfunction. A significant increase in fatal chest infections was noted in HCV-positive patients. Overall mortality was higher in HCV-positive patients, but it was not statistically significant. All measures should be taken to prevent HCV transmission in the dialysis population. Renal transplant recipients with HCV infection need close monitoring for both graft and liver function.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Chronic Viral Hepatitis on Graft Survival in Saudi Renal Transplant Patients

Mitwalli¹,

Alam

Al-Wakeel³

et al. 2005

Nephron Clin Pract

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“…Some of this confusion may have arisen from the methods of detection of HCY positivity, which in many early studies relied on a first generation assay with a significant false-positive rate. Pereira et al 19 showed that 75% of seropositive donors transmitted HCY to the transplant recipient. In contrast.…”

Section: The Donor With Hepatitis Cmentioning

confidence: 99%

High-risk donors: expanding donor criteria

Jordan

Shapiro

Vivas

et al. 1999

Transplantation Proceedings

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“…This prevalence may be as high as 6 % in some regions of Africa and the Middle East (Darwish et al, 1993). Since HCV is mainly transmitted via blood, haemo-derivatives and haemodialysis, the main populations at risk are drug addicts, the recipients of blood transfusions and of haemodialysis (Alter, 1989), organ transplants (Pereira et al, 1991) and tattoos (Ko et al, 1992) and health-care personnel (Polish et al, 1993). Approximately 80 % of patients suffering from acute hepatitis C develop chronic hepatitis (Lau et al, 1993) and 20-35 % develop liver cirrhosis (Alter, 1989).…”

Section: Introductionmentioning

confidence: 99%

Immunogenicity of variable regions of hepatitis C virus proteins: selection and modification of peptide epitopes to assess hepatitis C virus genotypes by ELISA.

Rodríguez-López

Riezu‐Boj

Ruiz

et al. 1999

Journal of General Virology

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The immunogenicity of variable regions of hepatitis C virus (HCV) proteins was studied by ELISA by using 543 synthetic peptides from 120 variable regions and 90 sera from HCV-infected patients. Some regions from certain genotypes were less immunogenic, or even non-immunogenic, compared with their equivalents in other genotypes. However, the mean recognition of all peptides from genotypes 1a, 1b and 3 by sera infected with genotypes 1a, 1b and 3, respectively, showed no significant differences, suggesting a similar overall immunogenicity of variable regions from these genotypes. Proteins NS4a, NS4b and NS5a were found to be the most immunogenic. Recognition of individual peptides by the sera of infected patients showed that the humoral response against HCV is patient-dependent. The work shows that 15-mer peptides may encompass several B-cell epitopes. These epitopes may lie in slightly different positions in different genotypes. Thirty-one percent of the 543 peptides were recognized by some of the 35 healthy donors. This may be a reflection of the large number of antigens to which they had been exposed, but it may also reflect a strategy of HCV to respond to immune pressure. After selection and modification, a set of 40 peptides was used to assess genotypes 1a, 1b, 1, 2 and 3 in the sera of HCV-infected patients, with sensitivities of 34n1, 48n5, 68n8, 58n3 and 48n9 % and specificities of 100, 99n1, 97n1, 99n5 and 99 %, respectively. The overall sensitivity and specificity for the assessment of genotypes 1, 2 and 3 were 64 and 98 %, respectively.

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Transmission of Hepatitis C Virus by Organ Transplantation

Abstract: Organ transplantation can transmit hepatitis C. This raises serious questions about the continued acceptance of organs from donors positive for anti-HCV.

Cited by 350 publications

References 34 publications

Effect of Chronic Viral Hepatitis on Graft Survival in Saudi Renal Transplant Patients

Effect of Chronic Viral Hepatitis on Graft Survival in Saudi Renal Transplant Patients

High-risk donors: expanding donor criteria

Immunogenicity of variable regions of hepatitis C virus proteins: selection and modification of peptide epitopes to assess hepatitis C virus genotypes by ELISA.

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