Impact of hepatitis C on renal transplantation: a long-term study

Viral hepatitis, especially "C" type (HCV), is an important cause of morbidity and mortality among recipients of renal transplants. In a retrospective long-term study, we reviewed 399 renal transplant patients (133F, 266M) who received 415 kidneys during the past eight-years. We evaluated their HCV infection and liver status. Stored sera (frozen at 80 C) as well as fresh sera collected at the time of transplant and/or at the last observation were used. The donors were cadavers in 386 and living related in 29 renal transplants. The mean follow-up period was 74 months (range 24-124 months). At the time of transplantation 105 recipients (26%) were HCV positive. A the last follow-up 105 (26%) recipients remained positive, 12 (2.8%) seroconverted from negative to positive due to graft and/or blood transfusion and 277 remained negative. Liver biopsy was obtained from 71 to 117 (60.6%) HCV +ve patients. Liver biopsy showed normal histology in 57 (80%) patients, chronic active hepatitis in 42 (59%) patients according to scoring of Knodle's classification. Recurrence of glomerulonephritis in renal allografts occurred in 21 patients. Membrano proliferative glomerulonephritis ( PGN) occurred in nine patients; seven (78%) of them were HCV +ve compared to 29% HCV +ve in the whole group (117/399) (P< 0.001). The actuarial patient and graft survival was similar in HCV-ve and HCV +ve patients. We conclude that HCV is an important cause of liver disease in renal allograft recipients, it might be the cause of recurrence of MPGN, however, it affects neither patients nor graft survival.