Long-Term Impact in Hepatitis C Virus Infection in Post Renal Transplantation

Abstract

Introduction: infection by hepatitis C virus (HCV) is the main cause of chronic liver disease in patients with chronic kidney disease in dialysis treatment and submitted to renal transplantation. Some publications have reported that chronic liver disease secondary to HCV infection is an important cause of morbidity and mortality after kidney transplantation. The authors evaluated the impact of chronic hepatitis C virus (HCV) infection in kidney transplant recipients analyzing post-transplant complications, patient and graft survival. Methods: retrospective study with 40 kidney transplant recipients with HCV infection and 40 matched kidney transplant recipients without HCV infection submitted to renal transplantation in the same period at our institution. The presence of anti-HCV antibodies was tested using Elisa method of first generation, in the period from 1990 to 1992, second generation from 1992 to 1997 and third generation after the year of 1997. The HCV positive (HCV+) patients were submitted to a liver biopsy prior to renal transplantation and none presented active chronic hepatitis or cirrhosis at that time. The control patients (HCV-) were selected using demographic characteristics in order to closely resemble the HCV + patients. The following variables were analyzed: age, gender and race of the receipients, donor type (living or deceased), HLA profile, time of the transplantation, current kidney function, graft and patient survival, time and cause of graft loss or death, immunosuppressive drugs and complications. Results: the average follow-up after transplantation was 12.3 + 4.5 years in patients with HCV infection and 12.5 + 2.9 years in patients without HCV infection (p=0.49). There was no statistical difference related to age, race and gender of the recipients nor donors' age and type. The incidence of haploidentical HLA was higher in the HCV - patients (p=0,05).The initial immunosuppressive therapy dose in both groups was similar and consisted of cyclosporine (8mg/kg/day) or tacrolimus (0.2 mg/kg/day), azathioprine (2mg/kg/day) or mycophenolate mofetil (2.0g/day) and prednisone (0.5mg/kg/day). There was no statistical difference related to immunosuppressive therapy in both groups (p=0,87), predominating the protocol cyclosporine (CSA), azathioprine (AZA) and prednisone (PRED). The current renal function estimated with the Cochroft-Gault formula in patients with HCV infection was 47.3 + 24.9 ml/min/1,73m2 and 54.9 + 27.2 ml/min/1,73m2 in the control group (p= 0.48). The Kaplan- Meier analysis revealed that graft and patient survival was similar in both groups (p=0.24 and p=0.54 respectively). The incidence of acute rejection was 35% in patients with HCV infection and 25% in patients without HCV infection (p=0.26). The main cause of death in both groups was bacterial infection (10% in the HCV + patients and 12.5% in the HCV - patients, p=0.63).The incidence of diabetes mellitus did not differ statistically. Abnormal liver enzymes levels (in two patients) and cirrhosis (in one patient) were observed only in the HCV+ group. Conclusion: in this patient population, HCV infection did not impact on patient or graft survival. One must take into account the relative small sample size and the retrospective nature of the analysis which are the limitations of the present study.