Premium
Time of acquisition of HCV infection in renal transplant recipients: a major prognostic factor for disease progression
Author(s) -
Delladetsima Ioanna,
Psichogiou Mina,
Sypsa Vana,
Sakellariou Stratigoula,
Hatzakis Angelos,
N. Boletis John
Publication year - 2012
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12012
Subject(s) - medicine , transplantation , immunosuppression , hepatitis c , liver transplantation , gastroenterology , risk factor , kidney disease , hepatitis c virus , liver disease , immunology , virus
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.