title: Impact of immunosuppressive therapy on hepatitis C infection after renal transplantation.
abstract: BACKGROUND
  Among patients after renal transplantation (NTx), hepatitis C virus (HCV) infection is a risk factor for graft loss and patient death caused by hepatic decompensation. Also, HCV has been implicated in the pathogenesis of glomerular diseases in native and transplanted kidneys. Therefore, the aim of this retrospective cohort study was to determine the effects of the widely used calcineurin inhibitors (CNI) cyclosporine A (CsA) and tacrolimus (Tac) on hepatitis C virus replication, inflammatory activity, development of liver fibrosis, and long-term renal graft function.
  
  
  METHODS
  A cohort of 71 patients with HCV infection after kidney transplantation under immunosuppression with either CsA or Tac were analyzed for viral kinetics and serum transaminases. In addition, presence of liver fibrosis was detected by non-invasive measurements using the FibroScan. Graft function was determined biochemically. Patients with interferon therapy prior to transplantation were excluded from the study in order to avoid any impact of the antiviral therapy on outcomes.
  
  
  RESULTS
  In the early period after transplantation, hepatitis C viral load was lower in patients treated with Tac as compared to CsA. This effect became negligible 3 months after transplantation. However, hepatic inflammatory activity was reduced in the CsA-treated group. Extent of liver fibrosis was similar in both groups of HCV-infected patients as well as in a control group of non-HCV-infected patients after renal transplantation (NTx), respectively. Renal function and glomerular filtration rate, as calculated by the modification of diet in renal disease (MDRD) formula, were significantly better in patients treated with Tac.
  
  
  CONCLUSIONS
  During long-term immunosuppression, the CNIs cyclosporine A versus tacrolimus showed no significant differences in HCV-infected patients after renal transplantation with respect to viral replication and development of liver fibrosis. However, function of the renal graft is significantly better preserved in patients receiving tacrolimus.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Kahraman
authors.forename: O
authors.initials: O
authors.lastname: Witzke
authors.forename: A
authors.initials: A
authors.lastname: Scherag
authors.forename: C
authors.initials: C
authors.lastname: Pütter
authors.forename: M
authors.initials: M
authors.lastname: Miller
authors.forename: A
authors.initials: A
authors.lastname: Dechêne
authors.forename: S R
authors.initials: SR
authors.lastname: Ross
authors.forename: G
authors.initials: G
authors.lastname: Gerken
authors.forename: P
authors.initials: P
authors.lastname: Hilgard
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D005858:Germany; D006085:Graft Survival / Q000187:drug effects; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics / Q000254:growth & development; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000821:virology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*; D013997:Time Factors; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome; D019562:Viral Load; D014779:Virus Replication
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D016572:Cyclosporine; D000637:Transaminases; D016559:Tacrolimus