Long-term outcome in kidney transplant patients with hepatitis C (HCV) infection

Area of Science:

• Nephrology
• Hepatology
• Transplantation Immunology

Background:

• Hepatitis C virus (HCV) infection is a global health concern.
• Kidney transplant recipients are a vulnerable population with potential for chronic infections.
• The long-term impact of HCV on kidney transplant outcomes requires further investigation.

Purpose of the Study:

• To determine the prevalence of HCV antibodies in kidney transplant candidates.
• To evaluate the long-term effects of HCV infection on graft survival, function, and patient mortality post-transplantation.
• To assess the incidence and severity of liver disease in HCV-positive kidney transplant recipients.

Main Methods:

• Assayed 716 pre-transplant sera for anti-HCV antibodies using ELISA and confirmed with radioimmunoassay (RIA).
• Followed 638 kidney transplant recipients for 5 years, monitoring graft survival, function, liver enzymes (AST), mortality, and cause of death.
• Conducted liver biopsies on 80% of anti-HCV positive patients with elevated AST levels.

Main Results:

• Prevalence of anti-HCV antibody was 10.3% in the study cohort.
• No significant differences were found in graft function, graft survival, or overall patient mortality between anti-HCV positive and negative groups at 5 years.
• Anti-HCV positive patients showed higher peak and sustained AST levels, but severe chronic hepatitis was rare (12% of those biopsied).
• Approximately 9.7% of anti-HCV positive patients seroconverted to negative within 2-5 years post-transplant.

Conclusions:

• Pre-existing anti-HCV antibody positivity does not adversely affect long-term kidney graft survival or patient outcomes.
• Mild elevations in liver enzymes are common in HCV-positive recipients, but severe liver disease is infrequent.
• HCV infection status should not be a contraindication for kidney transplantation.