Long-term outcome in kidney transplant patients with hepatitis C (HCV) infection.
To assess the prevalence and long-term impact of HCV on kidney transplant recipients, we assayed 716 pre-transplant sera using a first-generation ELISA. The anti-HCV positive sera were confirmed by a 6-antigen radioimmunoassay (RIA). Patients were followed up for 5 years. Graft survival, function, evidence of chemical hepatitis (AST > 2x normal), patient mortality and cause of death were evaluated. The prevalence of anti-HCV antibody was 10.3%. In the 638 patients who were followed up for 5 years, there were no differences in graft function, graft survival, overall mortality, or death from sepsis or liver disease. Peak AST levels were significantly higher in anti-HCV positive patients compared to anti-HCV negative patients. At 5 years, the AST levels remained significantly higher in the anti-HCV positive group, however, this was only 6 U/1 > normal. Liver biopsies performed 3 to 7 years post-transplant in 80% of anti-HCV positive patients with chemical hepatitis showed 12% CAH, 50% mild hepatitis and 38% normal histology. Six (9.7%) patients seroconverted from anti-HCV positive to anti-HCV negative 2 to 5 years post-transplant. The presence of anti-HCV does not appear to alter long-term patient or graft survival, and histologic evidence of severe chronic liver disease was rare in anti-HCV positive patients with chemical hepatitis. From these results, the presence of anti-HCV antibody should not preclude kidney transplantation.
Orloff
S L
SL
Kidney Transplant Service, University of California, San Francisco 94143, USA.
Stempel
C A
CA
Wright
T L
TL
Tomlanovich
S J
SJ
Amend
W J
WJ
Stock
P G
PG
Melzer
J S
JS
Vincenti
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D002423:Cause of Death; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D016174:Hepacivirus / Q000276:immunology; D006505:Hepatitis / Q000201:enzymology / Q000473:pathology; D006508:Hepatitis Antibodies / Q000097:blood; D006526:Hepatitis C / Q000201:enzymology / Q000453:epidemiology* / Q000401:mortality; D006521:Hepatitis, Chronic / Q000201:enzymology / Q000473:pathology; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology; D017093:Liver Failure / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012495:San Francisco / Q000453:epidemiology; D018805:Sepsis / Q000401:mortality; D016896:Treatment Outcome
D006508:Hepatitis Antibodies; D001219:Aspartate Aminotransferases