Long-term impact of renal transplantation on liver fibrosis during hepatitis C virus infection.
OBJECTIVE
During hepatitis C virus (HCV) infection, liver fibrosis progression after renal transplantation remains controversial. The aim of this cohort study with controls was to compare liver histopathologic features during HCV infection between renal transplant recipients and matched groups of hemodialyzed patients or controls without renal disease and untreated for HCV.


METHODS
Each renal transplant recipient (group 1, n = 30) was matched at first liver biopsy (LB) using the main factors known to influence progression of fibrosis with one HCV hemodialyzed patient (group 2, n = 30) and one HCV-infected patient (nonhemodialyzed, nontransplanted; group 3, n = 30). Patients from group 1 were also matched with those of group 3 on the time between 2 consecutive LBs performed 37 months apart. LBs were evaluated according to the Knodell index, METAVIR score, and rate of fibrosis progression per year (fibrosis unit).


RESULTS
The rate of fibrosis progression per year between the first and second LBs was significantly lower (P = 0.03) in group 1 (0.067; 95% confidence interval: -0.05, 0.18) than group 3 (0.20; 95% confidence interval: 0.13, 0.26). At the second LB, the Knodell index and activity or fibrosis in METAVIR were lower in group 1 than group 3 (4.2 +/- 0.4 vs. 7.5 +/- 0.6, 0.5 +/- 0.1 vs. 1.3 +/- 0.2, and 1.4 +/- 0.2 vs. 2.3 +/- 0.2 respectively, P < 0.01).


CONCLUSIONS
Our study suggests that liver fibrosis progression is low in most HCV-infected renal transplant recipients with moderate liver disease at baseline.
Alric
Laurent
L
Service de Médecine Interne, Pavillon Dieulafoy, CHU Purpan, Toulouse, France. ALRIC.L@chu-toulouse.fr
Di-Martino
Vincent
V
Selves
Janik
J
Cacoub
Patrice
P
Charlotte
Frédéric
F
Reynaud
Didier
D
Piette
Jean-Charles
JC
Péron
Jean-Marie
JM
Vinel
Jean-Pierre
JP
Durand
Dominique
D
Izopet
Jacques
J
Poynard
Thierry
T
Duffaut
Michel
M
Rostaing
Lionel
L
D000328:Adult; D001706:Biopsy; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology* / Q000821:virology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012720:Severity of Illness Index