Is hepatitis C more aggressive in renal transplant patients than in patients with end-stage renal disease?
BACKGROUND
The eventual impact of immunosuppression on the natural history of hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD) is still unknown because of the lack of comparative data for HCV-infected patients with ESRD and renal transplant patients. The aim of this study was to compare the biochemical and histological characteristics of chronic HCV infection in renal transplants patients and ESRD patients undergoing hemodialysis.


METHODS
Thirty-eight renal transplant patients and 38 ESRD patients undergoing hemodialysis who were chronically infected with HCV and were matched for gender, age at infection, and estimated time of infection were included in the study. The groups were compared regarding laboratory and histological variables.


RESULTS
Renal transplant patients showed similar alanine aminotransferase and higher gamma-glutamyltransferase levels (P = 0.05) when compared with ESRD patients. Comparative analysis of histological variables revealed a higher proportion of cases with septal fibrosis (P = 0.04) and confluent necrosis (P = 0.01) among transplant-recipient patients. No difference between groups was observed regarding the intensity of portal and periportal inflammatory infiltrates. Steatosis was more prevalent among transplant-recipient patients (P < 0.001). There was no difference between groups regarding the prevalence of lymphoid aggregates or bile duct injury.


CONCLUSIONS
Renal transplant patients had a larger proportion of cases with septal fibrosis and confluent necrosis than did ESRD patients, suggesting that renal transplantation might modify the natural history of hepatitis C in ESRD patients, leading to a more aggressive liver disease.
Perez
Renata M
RM
Department of Internal Medicine, Federal University of Rio de Janeiro, Brazil.
Ferreira
Adalgisa S P
AS
Medina-Pestana
José O
JO
Cendoroglo-Neto
Miguel
M
Lanzoni
Valeria P
VP
Silva
Antonio Eduardo B
AE
Ferraz
Maria Lucia G
ML
D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D019698:Hepatitis C, Chronic / Q000473:pathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000473:pathology* / Q000628:therapy; D016030:Kidney Transplantation; D008111:Liver Function Tests; D008297:Male; D006435:Renal Dialysis; D018709:Statistics, Nonparametric