title: Time of acquisition of HCV infection in renal transplant recipients: a major prognostic factor for disease progression.
abstract: BACKGROUND
  This study aims to identify crucial factors affecting the evolution of liver disease in HCV-infected renal transplant recipients.
  
  
  METHODS
  Forty-two HCV-infected recipients with known time of HCV acquisition were followed up for a mean (SD) of 7.6 ± 3.4 yr after transplantation with consecutive liver biopsies. Hepatitis progression was defined by: a) fibrosis progression ≥ 0.2 stages/yr and/or b) development of a cholestatic syndrome.
  
  
  RESULTS
  Twenty-three patients (54.8%) displayed benign and 19 (45.2%) aggressive hepatitis progression. Hepatitis course was aggressive in 9.1% and 85% of the patients infected pre- and peri/post-transplantation, respectively (p < 0.001). In multivariate analysis, patients who acquired HCV infection peri- or after transplantation had an increased risk of an adverse outcome compared with those infected before transplantation (p = 0.001). HCV RNA levels at the time of first liver biopsy were lower in patients showing a benign course compared with those with aggressive evolution (p = 0.052).
  
  
  CONCLUSIONS
  Time of acquisition of HCV infection is a major prognostic factor for hepatitis progression in the setting of renal transplantation. Immunosuppression was found to be determinant in the progression of HCV infection acquired peri- or post-transplantation. High viral load seems to be crucial in the pathogenetic process.
authors.affiliation: First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece. jokadelladetsima@hotmail.com
authors.forename: Ioanna
authors.initials: I
authors.lastname: Delladetsima
authors.forename: Mina
authors.initials: M
authors.lastname: Psichogiou
authors.forename: Vana
authors.initials: V
authors.lastname: Sypsa
authors.forename: Stratigoula
authors.initials: S
authors.lastname: Sakellariou
authors.forename: Angelos
authors.initials: A
authors.lastname: Hatzakis
authors.forename: John
authors.initials: J
authors.lastname: N Boletis
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology*; D016174:Hepacivirus / Q000235:genetics / Q000472:pathogenicity*; D006526:Hepatitis C / Q000209:etiology* / Q000473:pathology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications; D011379:Prognosis; D012367:RNA, Viral / Q000235:genetics; D013997:Time Factors
chemical_list: D012367:RNA, Viral