The impact of hepatitis C virus infection on renal allograft recipients.
A second generation hepatitis C virus recombinant immunoblot assay (RIBA) was used to screen stored perioperative serum from 641 renal allograft recipients. One hundred and nine (17%) were anti-HCV positive at the time of transplant. RIBA positivity was found to be an independent predictor of post-transplant liver disease in a logistic regression model (P < 0.05). Moreover, RIBA positive patients were at greater risk for infectious events (P = 0.03) and rejection episodes (P = 0.002). The cumulative dose of antilymphoblast globulin administered as induction therapy was an independent predictor of post-transplant liver disease in a dose response relationship. Qualitative PCR showed that 74% of the perioperative RIBA positive patients had detectable HCV RNA in a current serum sample. Further, quantitative HCV RNA analysis with a competitive template PCR and HCV strain identification by restriction fragment length polymorphism demonstrated a large range of HCV RNA copies/ml of serum and three different HCV strains (BK, Hutch and HCV-1). Neither quantity of HCV RNA nor strain type correlated with abnormal transaminases post-transplant. As yet, there has not been an effect of anti-HCV status on actuarial patient and graft survival. This study suggests that anti-HCV is not a contraindication to renal transplantation; however, we would recommend that the pre-transplant evaluation of the anti-HCV positive patient include a liver biopsy to properly stage the disease. Close post-transplant follow-up is required in view of the increased risk for infection and rejection.
Roth
D
D
Department of Medicine, Miami Veterans Administration Hospital, Florida.
Zucker
K
K
Cirocco
R
R
DeMattos
A
A
Burke
G W
GW
Nery
J
J
Esquenazi
V
V
Babischkin
S
S
Miller
J
J
D000328:Adult; D001483:Base Sequence; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006508:Hepatitis Antibodies / Q000032:analysis; D006526:Hepatitis C / Q000503:physiopathology*; D018937:Hepatitis C Antibodies; D006801:Humans; D015151:Immunoblotting; D016030:Kidney Transplantation; D008107:Liver Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015335:Molecular Probes / Q000235:genetics; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications; D014184:Transplantation, Homologous
D006508:Hepatitis Antibodies; D018937:Hepatitis C Antibodies; D015335:Molecular Probes