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A prospective study of hepatitis C virus infection in renal allograft recipients
1Department of Medicine, University of Miami School of Medicine, Florida 33101, USA.
Insights
Hepatitis C virus (HCV) infection in kidney transplant patients is manageable, with no cases of liver failure observed. Further monitoring is recommended for long-term outcomes in this immunosuppressed population.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Immunology
Background:
- Hepatitis C virus (HCV) is a leading cause of post-transplant hepatitis in renal allograft recipients.
- Previous studies on HCV impact in kidney transplantation were retrospective, relying on transaminase levels.
- This study prospectively evaluates HCV-infected end-stage renal disease patients undergoing transplantation.
Purpose of the Study:
- To prospectively assess the outcomes of kidney transplantation in patients with Hepatitis C virus (HCV) infection.
- To investigate the correlation between pretransplant liver histology, immunosuppression, and post-transplant biochemical changes.
- To evaluate the incidence of complications such as cytomegalovirus (CMV) infection.
Main Methods:
- Prospective study of 14 HCV-infected end-stage renal disease patients.
- Pretransplant liver biopsies and close post-transplant virologic and biochemical monitoring.
- Follow-up averaged 11.6 months, assessing viral titers, liver enzymes (ALT), and clinical outcomes.
Main Results:
- Viral titers increased significantly post-transplant, especially after antilymphocyte therapy.
- All patients experienced a 2-3 fold increase in ALT, unrelated to histology or immunosuppression (FK506/cyclosporine).
- Higher incidence of cytomegalovirus infection observed in patients with pre-existing chronic hepatitis.
Conclusions:
- HCV-infected patients can undergo kidney transplantation with favorable short-term outcomes.
- No cases of fulminant liver failure occurred, and all grafts remained functional.
- Long-term monitoring, including sequential liver biopsies, is essential to understand HCV progression in immunosuppressed transplant recipients.
Abstract:
Hepatitis C virus (HCV) is the predominant cause of posttransplant non-A, non-B hepatitis among renal allograft recipients. Prior studies evaluating the impact of HCV in kidney transplantation have been retrospective in design and based largely on changes in serum transaminases. We studied a group of HCV-infected end-stage renal disease patients prospectively with pretransplant liver biopsies and close virologic and biochemical follow-up posttransplant. Fourteen patients have been followed a mean of 11.6 +/- 5.6 months posttransplant (range, 5-21 months). Six had changes of chronic hepatitis on pretransplant liver biopsy while 8 showed only mild histologic abnormalities. Circulating viral titers increased several-fold over baseline levels during posttransplant follow-up. Viral replication was particularly enhanced immediately following a course of antilymphocyte therapy. Although all patients showed a 2-3 fold increase in alanine aminotransferase (ALT) following transplantation, there were no association noted between pretransplant liver histology, the use of FK506 and/or cyclosporine-based immunosuppression, and the magnitude of ALT change posttransplant. The only clinical outcome found to differ significantly was a higher incidence of cytomegalovirus infection among patients with chronic hepatitis. All patients are alive with functioning grafts. There have been no episodes of fulmiinant or subfulminant liver failure. We conclude that HCV-infected patients can be safely transplanted with excellent short-term follow-up. Continued monitoring with sequential liver biopsies will be needed to define the long-term course of HCV infection in an immuno-suppressed population.