Natural history of hepatitis C virus-related liver fibrosis after renal transplantation.
The aim of our study was to assess hepatitis C virus (HCV) evolution and long-term liver histology outcome in anti-HCV(+)/RNA(+) renal transplant (RT) patients. A total of 51 anti-HCV(+)/RNA(+) RT patients underwent liver biopsies (LB) every 3-4 years after transplantation (two LBs, n = 51; three LBs, n = 42; four LBs, n = 9). The hypervariable region (HVR)-1 of the HCV genome from all patients was characterized over time. Overall, the rate of liver fibrosis progression was 0.09 +/- 0.03 Metavir units/year. We identified three groups of patients: those in whom liver fibrosis remained stable (n = 21), those with progressing liver fibrosis (n = 21) and those with a regression in liver fibrosis (n = 10). In the last two groups, the progression and the regression of liver fibrosis were gradual during follow-up. Ferritin levels and hepatosiderosis were significantly higher in fibrosers. Initial fibrosis stage and high diversification of the HVR-1 of HCV genome between transplantation and the first liver biopsy were independent factors associated with liver fibrosis regression. In conclusion, in the current study, more than 10 years after renal transplantation, HCV infection was not harmful upon liver histology in more than 50% of patients. The diversification of the HVR-1 might be used to predict liver fibrosis outcome.
Kamar
Nassim
N
Department of Nephrology, Dialysis and Multiorgan Transplantation, CHU Rangueil, Toulouse, Paris, France. nassim.kamar@free.fr
Rostaing
Lionel
L
Selves
Janick
J
Sandres-Saune
Karine
K
Alric
Laurent
L
Durand
Dominique
D
Izopet
Jacques
J
D000328:Adult; D019943:Amino Acid Substitution; D005260:Female; D005293:Ferritins / Q000097:blood; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000150:complications* / Q000821:virology; D006801:Humans; D007501:Iron / Q000378:metabolism; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation; D008099:Liver / Q000201:enzymology / Q000378:metabolism / Q000473:pathology; D008103:Liver Cirrhosis / Q000201:enzymology* / Q000378:metabolism / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012367:RNA, Viral / Q000097:blood; D014764:Viral Proteins / Q000235:genetics
C400562:HVR1 protein, Hepatitis C virus; D012367:RNA, Viral; D014764:Viral Proteins; D005293:Ferritins; D007501:Iron