Impact of HCV infection on development of posttransplantation diabetes mellitus in renal allograft recipients

Gürsoy, Murat; Güvener, Nilgün; Köksal, R.; Karavelioğlu, D; Baysal, C; Özdemir, Nurhan; Boyacıoğlu, Sedat; Bi̇lgi̇n, N; Erdal, Rengin

doi:10.1016/s0041-1345(00)00890-3

Cited by 63 publications

(32 citation statements)

References 7 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: 48%

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: 48%

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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“…There are a few published reports in transplant populations, both liver and kidney transplant recipients (21,23,26,30). In these studies, the PTDM incidence has generally ranged from 20 to 30%.…”

Section: Discussionmentioning

confidence: 99%

Association of Hepatitis C with Posttransplant Diabetes in Renal Transplant Patients on Tacrolimus

Bloom

Rao²,

Weng³

et al. 2002

Journal of the American Society of Nephrology

245

143

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Abstract. Posttransplant diabetes mellitus (PTDM) remains a common complication of immunosuppression. Although multiple risk factors have been implicated, none have been clearly identified as predisposing to the increased PTDM frequency observed in patients on tacrolimus. Hepatitis C virus (HCV) has been associated with diabetes and is a significant renal transplant comorbidity. In this study, records of 427 kidney recipients who had no known diabetes before transplantation were retrospectively examined. A multivariate logistic regression model was fit with covariates that had unadjusted relationships with PTDM to examine the independent relationship of HCV and the odds of development of PTDM by 12 mo posttransplant. A potential interaction between HCV and the use of tacrolimus as maintenance therapy on the odds of the development of PTDM was examined. Overall, PTDM occurred more frequently in HCV ϩ than HCV Ϫ patients (39.4% versus 9.8%; P ϭ 0.0005). By multivariate logistic regression, HCV (adjusted odds ratio [OR], 5.58; 95% confidence interval [CI], 2.63 to 11.83; P ϭ 0.0001), weight at transplantation (adjusted OR 1.028; 95% CI, 1.00 to 1.05; P ϭ 0.001), and tacrolimus (adjusted OR, 2.85; 95% CI, 1.01 to 5.28; P ϭ 0.047) were associated with PTDM. A significant interaction (P ϭ 0.0001) was detected between HCV status and tacrolimus use for the odds of PTDM. Among the HCV ϩ cohort, PTDM occurred more often in tacrolimus-treated than cyclosporine A-treated patients (57.8% versus 7.7%; P Ͻ 0.0001). PTDM rates in HCV Ϫ patients were similar between the two calcineurin inhibitors (10.0% versus 9.4%; P ϭ 0.521, tacrolimus versus cyclosporine A). In conclusion, HCV is strongly associated with PTDM in renal transplant recipients and appears to account for the increased diabetogenicity observed with tacrolimus.

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“…After two early reports, underlining a rather strong association between ongoing HCV infection and post-KT T2D [53,54] , a major retrospective analysis on 427 kidney recipients without T2D before KT [55] showed that, by multivariate logistic regression, HCV (adjusted OR 5.58; 95% CI: 2.63-11.83; P = 0.0001), weight at transplantation (adjusted OR 1.028; 95% CI: 1.00-1.05; P = 0.001), and tacrolimus (adjusted OR 2.85; 95% CI: 1.01-5.28; P = 0.047) were associated with newly onset T2D after KT. 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] .…”

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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Impact of HCV infection on development of posttransplantation diabetes mellitus in renal allograft recipients

Cited by 63 publications

References 7 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

Association of Hepatitis C with Posttransplant Diabetes in Renal Transplant Patients on Tacrolimus

Hepatitis C virus and type 2 diabetes

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