title: Outcome of hepatitis C virus-associated membranoproliferative glomerulonephritis after liver transplantation.
abstract: BACKGROUND
  Hepatitis C virus was the most frequent cause of liver failure requiring liver transplantation in our series. Hepatitis C virus infection has been associated with glomerulonephritis and, more frequently, type I membranoproliferative glomerulonephritis. Renal disease in patients with liver failure is often clinically silent and difficult to diagnose; thus, biopsy is required to establish the diagnosis. Our aim was to study the evolution of six patients diagnosed with membranoproliferative glomerulonephritis some months before liver transplantation.
  
  
  METHODS
  Liver transplantation alone was performed in four patients and combined liver-kidney transplantation in the remaining two, who were on hemodialysis for kidney failure. These patients were followed for a mean of 38.3+/-7.8 months. Evolution of proteinuria, renal function, hepatic function, and hepatitis C virus activity was studied.
  
  
  RESULTS
  In the four patients who underwent liver transplantation alone, proteinuria became negative initially and renal function remained stable. Proteinuria reappeared and renal function was altered in two of these patients at 17 and 36 months of follow-up, respectively, coinciding with a recurrence of active chronic hepatitis. In the two patients who received a combined liver-kidney transplant, proteinuria became negative, and their renal grafts currently maintain normal renal function.
  
  
  CONCLUSIONS
  Membranoproliferative glomerulonephritis does not constitute an absolute contraindication for liver transplantation alone; combined liver-kidney transplantations are reserved for patients with end-stage kidney failure. Proteinuria is reversed after liver transplantation, and recurrence seems to be associated with severe hepatitis C virus hepatic allograft disease relapse.
authors.affiliation: Department of Nephrology, Hospital General Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Spain.
authors.forename: M C
authors.initials: MC
authors.lastname: Cantarell
authors.forename: R
authors.initials: R
authors.lastname: Charco
authors.forename: L
authors.initials: L
authors.lastname: Capdevila
authors.forename: V
authors.initials: V
authors.lastname: Vargas
authors.forename: J L
authors.initials: JL
authors.lastname: Lazaro
authors.forename: E
authors.initials: E
authors.lastname: Murio
authors.forename: L
authors.initials: L
authors.lastname: Piera
authors.forename: C
authors.initials: C
authors.lastname: Margarit
mesh_terms: D000328:Adult; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000821:virology*; D006526:Hepatitis C; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation; D008099:Liver / Q000503:physiopathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome