Natural history of hepatitis C virus infection in adult renal graft recipients.

Abstract

AIM:

To study the natural history of hepatitis C virus infection in renal transplantation, 464 HbsAg negative patients were prospectively studied from 1989.

METHODS:

AntiHCV was tested by ELISA II and HCVRNA by Amplicor HCV RNA tests.

RESULTS:

Two hundred nine patients were antiHCV positive (C+). HCVRNA was confirmed in 89% of C+ patients. Compared with the 255 anti-HCV negative (C-), C+ had undergone longer periods of dialysis (P = .0001), were more transfused (P = .01), and included more retransplants (P = .002). Immunosuppression was azathioprine (AZA) plus steroids in 133 and cyclosporine (CsA) in 331 patients. Liver biopsy showed chronic active hepatitis in 50, cirrhosis in 8, and fibrosing cholestatic hepatitis in 2 patients. Histologic progression of liver disease was confirmed in 18 of 26 patients. The causes of death in 84 patients (51 C+ vs 33 C-) were cardiovascular disease in 49%, sepsis in 13%, liver failure in 14%, neoplasia in 21%, and hepatocarcinoma in 2%. The 14-year patient survival was 75% in C+ and 86% in C- (P = .002). By multivariate analysis, age (>40) (P = .001) and C+ (P = .019) correlated with a worse patient survival. If patients were stratified according to age (<40 vs > or =40), younger C+ patients had a lower survival probability (P = .03). The 14-year graft survival was 44% in C+ vs 60% in C- patients (P = .001) but pure graft survival was similar (68% in C+ vs 72% in C-) (P = .13).

CONCLUSION:

The presence of C+ significantly reduced both patient and graft survival in the long-term with liver failure being the second most frequent cause of death.

• Authors: A Aroldi, P Lampertico, G Montagnino, G Lunghi, P Passerini, M Villa, M Campise, B M Cesana, C Ponticelli
• Journal: Transplantation proceedings (Transplant Proc) Vol. 37 Issue 2 Pg. 940-1 (Mar 2005) ISSN: 0041-1345 [Print] United States
• PMID: 15848581 (Publication Type: Journal Article)

Chemical References

• Hepatitis C Antibodies
• Immunosuppressive Agents
• RNA, Viral

Topics

• Adult
• Cause of Death
• Chi-Square Distribution
• Drug Therapy, Combination
• Enzyme-Linked Immunosorbent Assay
• Graft Survival
• Hepatitis C (physiopathology)
• Hepatitis C Antibodies (blood)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Kidney Transplantation (mortality, physiology)
• Liver Failure (etiology, mortality)
• RNA, Viral (isolation & purification)
• Recurrence
• Survival Analysis