The course of hepatitis C virus infection in pretransplantation anti-hepatitis C virus-negative renal transplant recipients: a retrospective follow-up study.
BACKGROUND
The aim of this study is to evaluate the natural course of hepatitis C virus (HCV) infection in renal transplant recipients infected shortly before or after renal transplantation.


METHODS
Seventeen renal transplant recipients with no detectable antibodies to HCV before renal transplantation either seroconverted after transplantation or developed cholestatic syndrome without seroconversion, but with HCV RNA positivity. They were followed up for a mean of 7.2 +/- 4.2 (SD) years after renal transplantation and underwent consecutive liver biopsies.


RESULTS
Biochemical abnormalities initially were observed a median of 5.7 months (25th, 75th percentiles, 2.4, 13.9) after transplantation. Initial liver biopsies showed acute hepatitis in 5 patients and chronic hepatitis in 9 patients, whereas 3 patients had histological findings of fibrosing cholestatic hepatitis. During a median follow-up of 2.0 years (25th, 75th percentiles, 1.3, 4.6), the condition of 5 patients, initially with diagnoses of acute hepatitis, deteriorated rapidly, with a median fibrosis progression rate of 0.77 (25th, 75th percentiles, 0.56, 0.86) per year. Six patients with chronic hepatitis progressed with a median fibrosis progression rate of 0.35 (25th, 75th percentiles, 0.15, 0.69) per year in a median of 3.1 years (25th, 75th percentiles, 2.4, 3.5), whereas the other 3 patients with chronic hepatitis with elevated cholestatic liver enzyme levels developed early fibrosing cholestatic hepatitis (1 patient) or vanishing bile duct syndrome (2 patients). Genotype 1 was found in 7 of 9 patients with fibrosing cholestatic hepatitis or vanishing bile duct syndrome (78%; P = 0.049). Six of 17 patients died a median of 6.1 years (25th, 75th percentiles, 1.5, 7.1) posttransplantation; 4 of these 6 patients died of hepatic failure.


CONCLUSIONS
HCV infection acquired shortly before or after renal transplantation frequently is associated with an adverse clinical outcome, characterized by rapid progression of fibrosis, development of cholestatic syndrome, and high mortality rate. Acute hepatitis occurring under maximal immunosuppression is of great prognostic significance, determining a specific high-risk group.
Delladetsima
Ioanna
I
Department of Pathology, Transplant Center, Laiko General Hospital, Athens University Medical School, Athens, Greece. jokadelladetsima@hotmail.com
Psichogiou
Mina
M
Sypsa
Vana
V
Psimenou
Erasmia
E
Kostakis
Alkiviadis
A
Hatzakis
Angelos
A
Boletis
John N
JN
D005260:Female; D005500:Follow-Up Studies; D018937:Hepatitis C Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000209:etiology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
D018937:Hepatitis C Antibodies