Epidemiology of HCV infection: disease and renal transplantation.
We studied the prevalence of HCV infection in a cohort of 346 patients who received renal transplantation between January 1989 and April 1994. Assessments were made at the time of surgery, one year later and at the last follow-up visit. The hepatic consequences of HCV infection were also studied. The prevalence of HCV infection at the time of surgery was 21.4% (74/346). The risk factors associated with the presence of anti-HCV antibodies were: duration of haemodialysis, the number of transfusions and the number of previous renal transplantations. The incidence of HCV infection was 3% (8/272) and was accompanied by either transient (n = 4) or chronic (n = 3) hepatic cytolysis; five patients underwent liver biopsy which revealed persistent chronic hepatitis (n = 2) or active chronic hepatitis (n = 3). Seroconversion always occurred within one year following transplantation. In the long-term, 91% of HCV+ patients remained viraemic. The HCV genotype was predominantly 1b. Fifty-six per cent (56%) of HCV+ patients had normal ALAT at the time of transplantation, which remained normal on follow-up in two-thirds of cases. After transplantation, 39 HCV+ patients underwent liver biopsy. ALAT were normal in 13 of those; liver biopsy elicited either normal liver (n = 1) or chronic persistent hepatitis (CPH) (n = 8) or chronic active hepatitis (CAH) (n = 4). ALAT were chronically elevated in 26 patients; liver histology revealed: 7 CPH, 19 CAH including 12 cases with bridging fibrosis. No deleterious effect of azathioprine on liver histology was found. Lastly, four patients were co-infected with HBV: all had elevated ALAT; liver biopsy always revealed severe chronic active hepatitis. Post-transplantation hepatitis C is a worrying problem. Liver enzymes are not correlated with the severity of histological disorders, which are frequent. Interferon-alpha therapy should be proposed to HCV+ patients before renal transplantation.
Cisterne
J M
JM
Department of Nephrology, CHU Purpan, Toulouse, France.
Rostaing
L
L
Izopet
J
J
Chabannier
M H
MH
Baron
E
E
Duffaut
M
M
Durand
D
D
Suc
J M
JM
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D000914:Antibodies, Viral / Q000032:analysis; D002908:Chronic Disease; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology; D006526:Hepatitis C / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012367:RNA, Viral / Q000032:analysis; D011863:Radioimmunoassay; D012189:Retrospective Studies; D012307:Risk Factors
D000914:Antibodies, Viral; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D000410:Alanine Transaminase