Association between hepatitis C virus infection and development of posttransplantation diabetes mellitus in renal transplant recipients12

Yldz, Alaattin; T??t??nc??, Yldz; Yazc, Halil; Akkaya, Vakur; Kayacan, Seyit Mehmet; Sever, Mehmet ????kr??; ??arin, Mahmut; Kar??da??, Kubilay

doi:10.1097/00007890-200210270-00009

Cited by 50 publications

(26 citation statements)

References 24 publications

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“…Several authors have reported the presence of an association between HCV infection and the development of posttransplantation diabetes mellitus, both after liver transplantation (27) and RT (28,29). None of our patients presented with posttransplantation diabetes mellitus.…”

Section: Discussionmentioning

confidence: 49%

Evidence that Clearance of Hepatitis C Virus RNA after α-Interferon Therapy in Dialysis Patients Is Sustained after Renal Transplantation

Kamar

Toupance²,

Büchler³

et al. 2003

Journal of the American Society of Nephrology

175

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Abstract. To date, there is no available treatment of hepatitis C virus (HCV) infection after renal transplantation (RT). Among 55 anti-HCV-positive/HCV RNA-positive hemodialysis patients who were treated with IFN-␣ (9 MU/wk during 6 or 12 mo), 21 of them (38%) had a sustained virologic response. Of these, 16 (76%) underwent RT 38 mo (range, 2 to 57 mo) after ␣-IFN therapy. There were 13 men and 3 women aged 46 yr (range, 27 to 68 yr). At RT, HCV serology was still positive in 15 patients, and HCV viremia was negative in all patients. Immunosuppression relied on anticalcineurin agents with or without steroids and/or antimetabolites; in addition, 12 of them received induction therapy with antithymocyte globulins. At the last follow-up after RT, at 22.5 mo (range, 2 to 88 mo), HCV viremia remained negative in all patients. Moreover, HCV RNA was not present in peripheral blood mononuclear cells when assessed in eight patients. HCV serology was found to be still positive in 13 patients. Three patients presented with acute rejection, one presented with a suppurative lymphocele, one died from a sepsis, and four presented with a cytomegalovirus infection. None of them developed posttransplant diabetes mellitus. In conclusion, hemodialysis patients waiting for a RT need to be treated with ␣-IFN because when HCV RNA clearance occurred, they experienced no relapse after transplantation despite chronic immunosuppressive treatment.Despite the screening of blood donors for hepatitis C virus (HCV) and the use of recombinant erythropoietin for the treatment of anemia in end-stage renal failure, de novo cases of HCV infection still occur that result from nosocomial transmission. Hence, the prevalence of HCV infection in hemodialysis patients and renal transplant recipients remains high. HCV-positive renal transplant recipients' survival is higher than that of HCV-positive hemodialysis patients. Nevertheless, patient and graft survivals are lower in HCV-positive renal transplant patients compared with HCV-negative renal transplant recipients (1). After RT, immunosuppression results in a significant increase in HCV viremia (2). Moreover, there is no efficient and safe treatment of HCV infection in renal transplant recipients. The treatment of HCV-positive renal transplant recipients with IFN-␣ is associated with a low rate of HCV RNA clearance and a high rate of acute rejection (3). Ribavirin monotherapy in renal transplant recipients is associated with an improvement in liver enzymes; however, HCV viremia did not change significantly. In contrast, liver fibrosis progressed significantly after 1 yr of ribavirin monotherapy (4). The treatment of HCV-positive hemodialysis patients with IFN-␣ is associated with a sustained virologic response ranging from 20% to 92% of the cases (5,6). We report on 16 cases of HCV-positive patients who cleared HCV viremia while they were treated with IFN-␣ during hemodialysis, and who did not relapse after renal transplantation (RT).Between 1993 and 1998, 55 anti-HCV-positive/HCV RNApositive hemodial...

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Section: Discussionmentioning

confidence: 49%

Evidence that Clearance of Hepatitis C Virus RNA after α-Interferon Therapy in Dialysis Patients Is Sustained after Renal Transplantation

Kamar

Toupance²,

Büchler³

et al. 2003

Journal of the American Society of Nephrology

175

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“…In this study, a significant interaction (P = 0.0001) was found between presence of HCV and use of tacrolimus, since in the HCV-positive group, T2D occurred more often in tacrolimus-treated than cyclosporine A-treated patients (57.8% vs 7.7%; P < 0.0001) [55] . Most subsequent studies confir med this robust association [56][57][58][59][60][61][62][63] , with some exceptions [21,[64][65][66] . Thus, in a recent meta-analysis of 10 studies, the pooled relative risk for post-KT T2D was 2.73 (95% CI: 1.94-3.83) [67] .…”

Section: Association Between Hcv and T2dmentioning

confidence: 95%

“…In addition to ongoing HCV infection, risk factors for developing T 2 D a f t e r K T a r e f a m i l y h i s t o r y o f T 2 D [ 5 5 , 6 0 ] , age [57,59,61,62] , use of tacrolimus [55,59,60,62,63] , smoking [61] , overweight/obesity [62,63] , African-American ethnicity [62] and pre-transplantation impaired fasting glucose [63] . Thus, there exists a significant increase of the risk of post-KT T2D in HCV-positive recipients, especially in the first 2 mo after transplantation [57] . Since T2D and its complications are a leading cause of mortality after KT, it is easy to understand that every effort should be made to clear HCV with antiviral therapy in the pre-KT period, whenever this is feasible.…”

Section: Association Between Hcv and T2dmentioning

confidence: 99%

Hepatitis C virus and type 2 diabetes

Negro¹,

Alaei²

2009

WJG

144

118

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This review focuses on the relationship between h e p a t i t i s C v i r u s ( H C V ) i n fe c t i o n a n d g l u c o s e metabolism derangements. Cross-sectional and longitudinal studies have shown that the chronic HCV infection is associated with an increased risk of developing insulin resistance (IR) and type 2 diabetes (T2D). The direct effect of HCV on the insulin signaling has been analyzed in experimental models. Although currently available data should be considered as preliminary, HCV seems to affect glucose metabolism via mechanisms that involve cellular pathways that have been implicated in the host innate immune response. IR and T2D not only accelerate the histological and clinical progression of chronic hepatitis C, but also reduce the early and sustained virological response to interferonalpha-based therapy. Thus, a detailed knowledge of the mechanisms underlying the HCV-associated glucose metabolism derangements is warranted, in order to improve the clinical management of chronic hepatitis C patients.

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“…This relation was not noted in our study and some older reports. 13,26 This may be explained by the small number of patients on tacrolimus without steroids and the short posttransplant duration of recipients on steroid-free immunosuppression because we used a different immunosuppressive protocol.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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Objectives: New-onset diabetes mellitus after transplant is a common complication in renal allograft recipients. Recently, a high prevalence of diabetes mellitus has been reported in patients with chronic hepatitis C virus. The association between hepatitis C and diabetes mellitus is well demonstrated in the general population, but some controversy still exists. This work aimed to study the effect of pretransplant hepatitis C virus on the development of new-onset diabetes mellitus after transplant in Egyptian livingdonor renal allotransplant recipients. Materials and Methods: This retrospective single center study included 913 kidney transplant recipients who were transplanted at Mansoura Urology and Nephrology Center between 2000 and 2010. The patients were divided into 4 groups according to their hepatitis C virus serology and diabetic status. Results: Pretransplant dialysis duration and number of blood transfusion units were statistically significant among both viremic and nonviremic groups. With respect to induction therapy, a highly statistical significance was observed between the 4 groups regarding presence and type of adjuvant therapy (P < .001). With respect to maintenance immunosuppression, high statistically significant results were observed regarding steroid and rapamycin between the 4 groups (P < .001) with lower significance regarding mycophenolate mofetil (P = .04) but no significance regarding azathioprine, cyclosporine, or tacrolimus therapy. Incidence of new-onset diabetes mellitus after transplant was statistically higher in the viremic than nonviremic group (P < .001). Conclusions: There was a positive correlation between incidence of new-onset diabetes mellitus after transplant and positive pretransplant hepatitis C virus status.

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Association between hepatitis C virus infection and development of posttransplantation diabetes mellitus in renal transplant recipients12

Cited by 50 publications

References 24 publications

Evidence that Clearance of Hepatitis C Virus RNA after α-Interferon Therapy in Dialysis Patients Is Sustained after Renal Transplantation

Evidence that Clearance of Hepatitis C Virus RNA after α-Interferon Therapy in Dialysis Patients Is Sustained after Renal Transplantation

Hepatitis C virus and type 2 diabetes

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