The Impact of Hepatitis C Infection and Antiviral Therapy on clinical Outcome in Renal Transplantation Recipients

Abstract

Hepatitis C viral infection (HCV) is presently a major problem in renal transplant recipients (RTR) with a high risk of chronicity resulting in liver cirrhosis. We screened 120 RTR (50 live related, 53 live unrelated, and 17 cadaveric); mean age of 45.2 years and mean post-transplant period of 6.8 years. Positive HCV antibodies using RIBA-2 test were detected in 43 patients (35.8%). Polymerase chain reaction was performed on 37 seropositive patients and confirmed viremia in 100% of hem. Forty-one seropositive patients (95.3%) had previous dialysis prior to transplantation; a mean of 4.5 years. Liver disease manifested in only five (11.6%) of the seropositive patients and hypertransaminasemia was detected in 14 (32.6%). Twelve seropositive patients with elevated transaminase levels and/or clinical evidence of liver disease, who all had positive PCR, underwent liver biopsy. Inflammation restricted to portal area was noticed in two, persistent hepatitis in three, chronic active hepatitis in four and cirrhosis in three. There was significantly higher incidence (P< 0.03) of acute graft rejection in the seropositive (23.3%) compared to the seronegative patients (9.1% ). While the difference did not amount to statistical significance for chronic rejection (9.3% and 6.5% respectively). Two patients had acute cellular rejection related to interferon therapy. The leading cause of death was related to liver failure in the seropositive patients and coronary artery disease in he seronegative RTR. In conclusion, there is high incidence of HCV in or renal transplant recipients associated with relatively high morbidity and mortality. At present we are lacking an efficient and well-tolerated antiviral drug.