Natural history of hepatitis B and C in renal allograft recipients.
BACKGROUND
In renal allograft recipients, most cases of liver dysfunction are caused by hepatitis B virus and hepatitis C virus (HCV). The natural history of hepatitis C and B was studied in 286 renal allograft recipients who received a kidney allograft between 1972 and 1989 when tests for anti-HCV became available.


METHODS
In all patients, hepatitis B (HB) surface (s) antigen (Ag) was tested before and anti-HCV (by enzyme-linked immunosorbent assay II) after transplantation.


RESULTS
At enrollment in 1989 (5.5+/-4 years after transplantation), 209 patients were anti-HCV positive (C+), 42 patients were HBsAg-positive (B+), and 35 patients were both B+ and C+ (C+B+). One hundred four patients were receiving azathioprine (AZA) and 182 were on cyclosporine A (CsA). Since transplantation, the median follow-up was 18 years in AZA-treated and 13 years in CsA-treated patients. Liver biopsy showed chronic hepatitis in 73 patients, cirrhosis in 20 patients, and fibrosing cholestatic hepatitis in 2 patients. In 34 patients, liver biopsy was repeated, and progression of fibrosis was observed in 24 patients. The 12-year patient survival rate was similar in B+, C+, and B+C+ patients (67%, 78%, and 71%, respectively; P=not significant). Liver-related death was the first cause of death in B+ and B+C+ infected patients (58% and 72%, respectively), whereas cardiovascular disease was the leading cause of death in C+ patients (40%). Multivariate analysis showed that older age (>40 years) (relative risk [RR], 2.8), B+ status (RR, 2.36), and C+ status (RR, 1.65) were independently associated with a worse patient survival.


CONCLUSIONS
In the long term, B+ patients had a higher risk of death related to liver disease than C+ patients, and co-infection did not worsen patient survival.
Aroldi
Adriana
A
Divisione di Nefrologia e Dialisi, Unità Operativa Nefrologia e Dialisi, Ospedale Maggiore IRCCS, Milano, Italy. aro@policlinico.mi.it
Lampertico
Pietro
P
Montagnino
Giuseppe
G
Passerini
Patrizia
P
Villa
Margherita
M
Campise
Maria R
MR
Lunghi
Giovanna
G
Tarantino
Antonio
A
Cesana
Bruno M
BM
Messa
PierGiorgio
P
Ponticelli
Claudio
C
D005500:Follow-Up Studies; D006085:Graft Survival; D006509:Hepatitis B / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D006526:Hepatitis C / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008099:Liver / Q000473:pathology / Q000821:virology; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents