title: Natural history of hepatitis C virus infection in adult renal graft recipients.
abstract: OBJECTIVE
  To study the natural history of hepatitis C virus infection in renal transplantation, 464 HbsAg negative patients were prospectively studied from 1989.
  
  
  METHODS
  AntiHCV was tested by ELISA II and HCVRNA by Amplicor HCV RNA tests.
  
  
  RESULTS
  Two hundred nine patients were antiHCV positive (C+). HCVRNA was confirmed in 89% of C+ patients. Compared with the 255 anti-HCV negative (C-), C+ had undergone longer periods of dialysis (P = .0001), were more transfused (P = .01), and included more retransplants (P = .002). Immunosuppression was azathioprine (AZA) plus steroids in 133 and cyclosporine (CsA) in 331 patients. Liver biopsy showed chronic active hepatitis in 50, cirrhosis in 8, and fibrosing cholestatic hepatitis in 2 patients. Histologic progression of liver disease was confirmed in 18 of 26 patients. The causes of death in 84 patients (51 C+ vs 33 C-) were cardiovascular disease in 49%, sepsis in 13%, liver failure in 14%, neoplasia in 21%, and hepatocarcinoma in 2%. The 14-year patient survival was 75% in C+ and 86% in C- (P = .002). By multivariate analysis, age (>40) (P = .001) and C+ (P = .019) correlated with a worse patient survival. If patients were stratified according to age (<40 vs > or =40), younger C+ patients had a lower survival probability (P = .03). The 14-year graft survival was 44% in C+ vs 60% in C- patients (P = .001) but pure graft survival was similar (68% in C+ vs 72% in C-) (P = .13).
  
  
  CONCLUSIONS
  The presence of C+ significantly reduced both patient and graft survival in the long-term with liver failure being the second most frequent cause of death.
authors.affiliation: Divisione de Nefrologia e Dialisi, Istituto di Medicina Interna, Istituto di Igíene e Medicina Preventiva, Ospedale Maggiore Milano IRCCS, Milan, Italy. aro@policlinico.mi.it
authors.forename: A
authors.initials: A
authors.lastname: Aroldi
authors.forename: P
authors.initials: P
authors.lastname: Lampertico
authors.forename: G
authors.initials: G
authors.lastname: Montagnino
authors.forename: G
authors.initials: G
authors.lastname: Lunghi
authors.forename: P
authors.initials: P
authors.lastname: Passerini
authors.forename: M
authors.initials: M
authors.lastname: Villa
authors.forename: M
authors.initials: M
authors.lastname: Campise
authors.forename: B M
authors.initials: BM
authors.lastname: Cesana
authors.forename: C
authors.initials: C
authors.lastname: Ponticelli
mesh_terms: D000328:Adult; D002423:Cause of Death; D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination; D004797:Enzyme-Linked Immunosorbent Assay; D006085:Graft Survival; D006526:Hepatitis C / Q000503:physiopathology*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D017093:Liver Failure / Q000209:etiology / Q000401:mortality; D012367:RNA, Viral / Q000302:isolation & purification; D012008:Recurrence; D016019:Survival Analysis
chemical_list: D018937:Hepatitis C Antibodies; D007166:Immunosuppressive Agents; D012367:RNA, Viral