Natural History of Hepatitis C Virus-Related Liver Fibrosis After Renal Transplantation

Kamar, Nassim; Rostaing, Lionel; Sèlves, Janick; Sandres-Sauné, Karine; Alric, Laurent; Durand, Dominique; Izopet, Jacques

doi:10.1111/j.1600-6143.2005.00918.x

Cited by 118 publications

(76 citation statements)

References 40 publications

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“…Further, Kamar et al suggested that HEV infection in kidney transplant recipients is more severe that HCV infection [17][28]. Some studies have proposed blood transfusion as a potential route of HEV transmission, particularly in areas of high endemicity [14][15][29].…”

Section: Discussionmentioning

confidence: 99%

Seroprevalence of Hepatitis E among Iranian Renal Transplant Recipients

Khameneh

Sepehrvand²,

Masudi

2011

Hepat Mon

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BackgroundRenal transplant recipients are known to be susceptible to viral infections, with more severe clinical presentations compared to healthy persons. Hepatitis E is generally a self-limited disease, which is caused by hepatitis E virus. Recently, hepatitis E has become more important in organ transplant recipients, because of new findings regarding the potential for chronic infections in this patient group.ObjectivesThis study aimed to evaluate the seroprevalence of anti-HEV IgG among kidney transplant recipients in Urmia, in the north-western region of Iran.Patients and Methods91 patients were selected randomly from amongst patients who had undergone kidney transplantation in Urmia, Iran. Each patient was tested for the presence of anti-HEV IgG antibody using an enzyme-linked immunosorbent assay (ELISA, Dia.Pro; Diagnostic Bioprobes, Italy).Results28 subjects (30.8%) were seropositive for anti-HEV IgG. Seropositive patients were generally older than seronegative patients (P = 0.009). There was no correlation between HEV infection and the level of education (P = 0.206), the history of blood transfusion (P = 0.164), or history of pre-transplantation hemodialysis (P = 0.228). There was no significant difference in the serum alanine aminotransferase (ALT) levels of the anti-HEV seropositive and seronegative patients. Multinomial logistic regression analysis indicated no significant relationship between HEV infection and increase in ALT levels, even after controlling for treatment with azathioprine (P = 0.79, OR = 1.12; 95% CI: 0.45–2.76).ConclusionThe anti-HEV IgG antibody has a high prevalence in Iranian kidney transplant recipients, and it is significantly higher in comparison with previous studies in the general population or in hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

Seroprevalence of Hepatitis E among Iranian Renal Transplant Recipients

Khameneh

Sepehrvand²,

Masudi

2011

Hepat Mon

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“…Using a matched immunocompetant control group, Zylberberg et al 39 reported more rapid progression of liver fibrosis in renal transplant recipients, whereas Alric et al 40 found just the opposite, with slower progression in the transplanted cohort. Interestingly, Kamar et al 41 reported variable outcomes including progression, stability, and even improvement in liver fibrosis among patients who underwent more than one post-transplant liver biopsy. It is important to emphasize that, unlike this analysis, none of the available studies had baseline pretransplant liver histology available for comparative purposes.…”

Section: Discussionmentioning

confidence: 99%

Effect of Kidney Transplantation on Outcomes among Patients with Hepatitis C

Roth¹,

Gaynor

Reddy³

et al. 2011

Journal of the American Society of Nephrology

129

128

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The long-term outcome of kidney transplantation in patients infected with hepatitis C virus (HCV) and end stage renal disease (ESRD) is not well described. We retrospectively identified 230 HCV-infected patients using enzyme immunoassay and nucleic acid testing obtained during the transplant evaluation. Of 207 patients who had a liver biopsy before transplant, 44 underwent 51 follow-up liver biopsies at approximately 5-year intervals either while on the waitlist for a kidney or after kidney transplantation. Advanced fibrosis was present in 10% of patients biopsied, identifying a population that may warrant consideration for combined liver-kidney transplantation. Kidney transplantation does not seem to accelerate liver injury; 77% of kidney recipients who underwent follow-up biopsies showed stable or improved liver histology. There was a higher risk for death during the first 6 months after transplant, but undergoing transplantation conferred a long-term survival advantage over remaining on the waitlist, which was evident by 6 months after transplant (HR, 0.32; 95% CI, 0.17 to 0.62). Furthermore, the risk for death resulting from infection was significantly higher during the first 6 months after transplant (HR, 26.6; 95% CI, 5.01 to 141.3), whereas there was an early (Յ6 months) and sustained decrease in the risk for cardiovascular death (HR, 0.20; 95% CI, 0.08 to 0.47). In summary, these data suggest the importance of liver biopsy before transplant and show that kidney transplantation confers a long-term survival benefit among HCV-infected patients with ESRD compared with remaining on the waitlist. Nevertheless, the higher incidence of early infection-related deaths after transplant calls for further study to determine the optimal immunosuppressive protocol.

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“…Sterling et al (15) have also reported that inflammatory activity and fibrosis were less intense in HD patients, although these differences were restricted to patients with elevated ALT as observed in our patients. In addition, HD patients have been described to have less advanced fibrosis and a lower degree of liver inflammation when compared with chronic renal failure patients not requiring dialysis (13,20) or to patients who underwent renal transplantation (19,21,22).…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C Is Less Aggressive in Hemodialysis Patients than in Nonuremic Patients

Trevizoli

Menezes²,

Velasco³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: The severity of liver disease among hepatitis C patients on hemodialysis is controversial. The aim of this study was to compare the clinical, biochemical, and liver histologic characteristics of hepatitis C virus (HCV) in hemodialysis patients and in those with normal renal function.Design, setting, participants, & measurements: A case-control study was carried out with 36 HCV patients on hemodialysis and 37 HCV patients with normal renal function matched for gender, age at infection, and estimated time of infection.Results: HCV patients on hemodialysis had lower levels of alanina aminotransferase and lower viral load. Hepatic fibrosis was significantly higher in the patients with normal renal function (73%) than in hemodialysis patients (47.2%, P < 0.025); the same was observed for inflammatory activity (control group 59.5% versus hemodialysis patients 27.7%, P ‫؍‬ 0.003). In addition, the risk of tissue inflammation was four times lower in hemodialysis patients (odds ratio ‫؍‬ 0.23, P < 0.004), and severe inflammatory activity on biopsy was the only independent risk factor for fibrosis (P < 0.001).Conclusions: The lower biochemical and inflammatory activities observed in hemodialysis patients suggest that hemodialysis and uremia may have a protective role against progression of the disease caused by HCV.

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Natural History of Hepatitis C Virus-Related Liver Fibrosis After Renal Transplantation

Cited by 118 publications

References 40 publications

Seroprevalence of Hepatitis E among Iranian Renal Transplant Recipients

Seroprevalence of Hepatitis E among Iranian Renal Transplant Recipients

Effect of Kidney Transplantation on Outcomes among Patients with Hepatitis C

Hepatitis C Is Less Aggressive in Hemodialysis Patients than in Nonuremic Patients

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