A Prospective Study of Hepatitis C Viremia in Renal Allograft Recipients

Abstract

In an attempt to study the impact of HCV viremia on renal transplant clinical course and outcome, we prospectively followed 133 HBsAg-negative end stage renal disease (ESRD) patients, in whom HCV-RNA-PCR results were available, from the pre- to post-transplant period. Eighty (60%) ESRD patients tested PCR-positive, of these, 12 (15%) were anti-HCV negative by second generation ELISA. The viremic patients had a longer time on dialysis (p < 0.001), received more blood units (p < 0.001) and had a higher frequency of pre-transplantation liver disease (p < 0.001). Further, 41% of PCR-positive patients gave a history of antischistosomal treatment compared with 23% of PCR-negative ones (p = 0.048). Recipients with and without HCV viremia were followed for a mean of 31.8 ± 5.8 (range 6–42) months and 29.8 ± 9 (range 6–41) months respectively, p = 0.14. While the prevalence of HCV viremia increased from 60 to 64% at the last follow-up, the anti-HCV seroprevalence decreased from 63 to 61%. PCR-positive patients had higher rates of both acute (p = 0.005) and chronic (p < 0.001) liver disease after transplantation compared with PCR-negative patients. However, none of our HCV RNA positive recipients developed a fulminant liver disease or hepatic failure until the last follow-up. Stepwise logistic regression analysis identified pre-transplant liver disease (Odds ratio = 2.4; p = 0.07) and a cumulative corticosteroid dose in excess of 15 g at the last follow-up (Odds ratio = 3; p = 0.03) as independent predictors of post-transplant hepatic dysfunction in PCR-positive patients. Azathioprine was discontinued due to hepatic dysfunction in a significantly (p = 0.005) higher proportion of viremic patients compared with the non-viremic ones. There were no significant differences between PCR-positive and -negative patients in terms of frequencies and individual causes of graft and patient losses. Our results demonstrate that HCV infection is extremely prevalent in Egyptian hemodialysis patients and is responsible for most hepatic dysfunctions after transplantation. Although HCV viremia did not negatively affect graft or patient outcome until 31 months post-transplantation, the authors would recommend that a viremic patient should have a liver biopsy before transplantation and be immunosuppressed with caution post-transplantation. A longer follow-up may be required to exclude increased rates of HCV-induced hepatic mortalities.

Effects of hepatitis C virus infection on haematocrite and haemoglobin levels in Egyptian hemodialysis patients

“…We and others have reported a high prevalence (16%) of HCV antibodies among healthy blood donors and a much higher prevalence (38%) of HCV antibodies among patients with glomerulopathy (10,11). It is known that the prevalence of HCV is higher among HD patients than the general population (12) with an even higher prevalence -as high as 60% -of hepatitis C viremia reported among our renal transplant recipients (13).…”

Impact of Hepatitis B and C Virus Infections on Kidney Transplantation: A Single Center Experience

“…The prevalences of HBV infection were 6.2% in 1994, 4 HBVϩ patients had been significantly longer on dialysis than negative patients (67.4 Ϯ 54.9 vs 35.3 Ϯ 32.9 months; P Ͻ .001). The acute rejection rate seemed to be higher among HBVϩ (48.1%) than negative patients (32.9%); however, the difference was not significant.…”

“…Some studies have reported an increased risk of death among patients who test positive for HCV antibody and HBsAg prior to kidney transplantation, 1,2 whereas others have reported no effect on patient or graft survivals. 3,4 The aim of this study was to evaluate the impact of HCV and HBV infections on renal transplant patients and their grafts, at a single center. This study also sought to analyze the evolution of prevalence of these infections over the last years in Portugal.…”

Efeito a longo prazo da infecção pelos vírus das hepatites B e C na sobrevida de pacientes transplantados renais

“…Muitos destes estudos publicados não têm demonstrado, de forma inequívoca, um efeito deletério desta infecção viral em pacientes transplantados renais a curto ou médio prazo 3,8,9 . No entanto, em estudos com maior tempo de seguimento tem-se demonstrado pior sobrevida dos pacientes anti-HCV positivos quando comparados aos anti-HCV negativos 10,11,12 .…”