Long-term outcome in kidney transplant patients with hepatitis C (HCV) infection.

To assess the prevalence and long-term impact of HCV on kidney transplant recipients, we assayed 716 pre-transplant sera using a first-generation ELISA. The anti-HCV positive sera were confirmed by a 6-antigen radioimmunoassay (RIA). Patients were followed up for 5 years. Graft survival, function, evidence of chemical hepatitis (AST > 2x normal), patient mortality and cause of death were evaluated. The prevalence of anti-HCV antibody was 10.3%. In the 638 patients who were followed up for 5 years, there were no differences in graft function, graft survival, overall mortality, or death from sepsis or liver disease. Peak AST levels were significantly higher in anti-HCV positive patients compared to anti-HCV negative patients. At 5 years, the AST levels remained significantly higher in the anti-HCV positive group, however, this was only 6 U/1 > normal. Liver biopsies performed 3 to 7 years post-transplant in 80% of anti-HCV positive patients with chemical hepatitis showed 12% CAH, 50% mild hepatitis and 38% normal histology. Six (9.7%) patients seroconverted from anti-HCV positive to anti-HCV negative 2 to 5 years post-transplant. The presence of anti-HCV does not appear to alter long-term patient or graft survival, and histologic evidence of severe chronic liver disease was rare in anti-HCV positive patients with chemical hepatitis. From these results, the presence of anti-HCV antibody should not preclude kidney transplantation.

[Endoscopic findings in the upper digestive tract in patients with terminal chronic kidney failure]. / Hallazgos endoscópicos del tracto digestivo superior en pacientes con insuficiencia renal crónica terminal.

We studied patients undergoing hemodialysis awaiting renal transplantation who had routine endoscopy as preoperative evaluation. Medical histories of 71 patients transplanted between 1982-1989 were reviewed retrospectively in order to determine the results of the upper gastrointestinal lesions. At the time of the endoscopy the predictive variables studied were: age, sex, BUN, creatinine, hemoglobin, hematocrit, calcium and time on hemodialysis. The patients were divided in two groups: those with lesions and a control group without lesions. The comparison between the two groups was done using unpaired t-test for continual variables, X2 for dichotomous variables and p < 0.05 was considered as statistically significant. Thirty two patients (45%) had lesions in the upper gastrointestinal tract, in the esophagus: 17%, stomach 30% and duodenum: 23%. Age was the only predictive variables statistically significant for gastric lesions. We conclude that gastrointestinal lesions are frequent in patients with end stage renal failure. The gastric lesions were the most frequent and appeared in older patients. We recommend endoscopic studies in all end stage renal failure patients as part of the pre transplant evaluation. We also suggest endoscopy as follow up after transplantation.

Hepatitis C--its prevalence in end-stage renal failure patients and clinical course after kidney transplantation.

There is a high incidence of chronic liver disease in end-stage renal failure patients on dialysis. Hepatitis C virus appears responsible for 80% of posttransfusion hepatitis, and up to 80% of sporadic hepatitis and cryptogenic cirrhosis. Anti-HCV antibodies correlate highly with the presence of active infection. The clinical implications of HCV infection in patients undergoing renal transplantation is unknown. Part I: We undertook a descriptive cross-sectional study of all renal failure patients admitted for kidney transplant between 1/84 and 12/88. Pretransplant sera were assayed for anti-HCV using an ELISA. Patients were divided into anti-HCV-positive (study group) and anti-HCV-negative (controls). Part II: A cohort study was performed with both groups followed from the time of transplantation to the present. Comparisons were made by t tests, chi-square analysis with Yates correction, Mann Whitney test for nonparametric results and multiple regression analysis. Part I: Anti-HCV was present in 76 of 716 sera assayed. There were no differences in sex, age, number of previous transplants, and underlying renal disease. Four variables predicted the presence of anti-HCV: number of blood transfusions; duration on dialysis; i.v. drug abuse, and nonwhite race. Part II: A group of 596 patients was further analyzed. The mean duration of follow-up was not different between the two groups. There were no differences in graft survival, overall mortality, or mortality secondary to liver disease or sepsis. Based on these results, the presence of anti-HCV should not be a contraindication for kidney transplantation.