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Hepatitis C--its prevalence in end-stage renal failure patients and clinical course after kidney transplantation
1Department of Medicine, University of California, San Francisco 94143.
Insights
Hepatitis C virus (HCV) infection is common in dialysis patients. This study found that anti-HCV antibodies did not negatively impact kidney transplant outcomes, suggesting it shouldn't be a contraindication.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Immunology
Background:
- Chronic liver disease is prevalent in end-stage renal failure patients on dialysis.
- Hepatitis C virus (HCV) is a significant cause of liver disease, including posttransfusion hepatitis and cryptogenic cirrhosis.
- The impact of HCV infection on renal transplant recipients was previously unknown.
Purpose of the Study:
- To investigate the clinical implications of Hepatitis C virus (HCV) infection in patients undergoing renal transplantation.
- To determine if the presence of anti-HCV antibodies affects graft survival, mortality, or liver-related complications post-transplant.
Main Methods:
- A descriptive cross-sectional study (Part I) of renal failure patients awaiting kidney transplant (1/84-12/88) to screen for anti-HCV antibodies using ELISA.
- Patients were categorized into anti-HCV-positive (study group) and anti-HCV-negative (control group).
- A subsequent cohort study (Part II) followed 596 patients post-transplantation, comparing outcomes between groups using statistical analyses (t tests, chi-square, Mann Whitney, regression analysis).
Main Results:
- Anti-HCV antibodies were detected in 76 of 716 pretransplant sera (10.6%).
- Predictors for anti-HCV positivity included more blood transfusions, longer duration on dialysis, intravenous drug abuse, and nonwhite race.
- No significant differences were observed in graft survival, overall mortality, or mortality from liver disease or sepsis between anti-HCV-positive and negative groups during follow-up.
Conclusions:
- The presence of anti-HCV antibodies in patients with end-stage renal disease should not be considered a contraindication for kidney transplantation.
- HCV infection does not appear to adversely affect renal transplant outcomes regarding graft survival or patient mortality.
- Further research may be warranted to explore long-term hepatic outcomes in HCV-positive transplant recipients.
Abstract:
There is a high incidence of chronic liver disease in end-stage renal failure patients on dialysis. Hepatitis C virus appears responsible for 80% of posttransfusion hepatitis, and up to 80% of sporadic hepatitis and cryptogenic cirrhosis. Anti-HCV antibodies correlate highly with the presence of active infection. The clinical implications of HCV infection in patients undergoing renal transplantation is unknown. Part I: We undertook a descriptive cross-sectional study of all renal failure patients admitted for kidney transplant between 1/84 and 12/88. Pretransplant sera were assayed for anti-HCV using an ELISA. Patients were divided into anti-HCV-positive (study group) and anti-HCV-negative (controls). Part II: A cohort study was performed with both groups followed from the time of transplantation to the present. Comparisons were made by t tests, chi-square analysis with Yates correction, Mann Whitney test for nonparametric results and multiple regression analysis. Part I: Anti-HCV was present in 76 of 716 sera assayed. There were no differences in sex, age, number of previous transplants, and underlying renal disease. Four variables predicted the presence of anti-HCV: number of blood transfusions; duration on dialysis; i.v. drug abuse, and nonwhite race. Part II: A group of 596 patients was further analyzed. The mean duration of follow-up was not different between the two groups. There were no differences in graft survival, overall mortality, or mortality secondary to liver disease or sepsis. Based on these results, the presence of anti-HCV should not be a contraindication for kidney transplantation.