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Nephrology Dialysis Transplantation, Vol 13, Issue 12 3103-3107, Copyright © 1998 by Oxford University Press

ORIGINAL ARTICLES

Clinicopathological features of rapidly progressive hepatitis C virus infection in HCV antibody negative renal transplant recipients

E Ok, A Unsal, A Celik, A Zeytinoglu, G Ersoz, Y Tokat, S Erensoy, U Akarca, A Basci and G Yuce
Departments of Nephrology, Microbiology, Gastroenterology, Surgery and Pathology, Ege University Medical School, Bornova 35 100, Izmir, Turkey; Corresponding author

Background. Hepatitis C virus (HCV) infection acquired during dialysis treatment generally shows a relatively benign course after renal transplantation (RTx). However, less is known about the course of HCV infection acquired during or after RTx. Methods. Clinical and histopathological assessment of 15 renal transplant recipients who acquired HCV infection during or after RTx. Results. Alanine aminotransferase levels rose for the first-time 1-19 weeks after RTx. HCV RNA was found positive in all patients, but anti-HCV became positive in only nine of them. During a mean follow-up of 21±12 months, jaundice appeared in 12 patients while ascites and/or hepatic encephalopathy occurred in six. Azathiprine was stopped in all patients. Cyclosporin was also stopped in four patients and in two of them prednisolone was also interrupted for a period of 3-7 weeks. Following this, ascites, hepatic encephalopathy and biochemical disturbances improved, while no deterioration was seen in graft function. Nine of the 15 patients had undergone two consecutive liver biopsies (LB). The first LP revealed cirrhosis in three and chronic hepatitis in six patients; the second LB showed cirrhosis in seven patients. The histological activity index (Knodell's score) progressed from 11.8±3.5 to 13.8±3.8. Conclusions. The results suggest that HCV infection acquired during or after RTx may run an unusual and rapidly progressive clinical and histopathological course at least in some of these patients. Decrease or withdrawal of immunosuppressive drugs may improve early hepatic failure without detrimental effect on graft function during that period. Keywords: cirrhosis; HCV antibody; Hepatitis C virus; hepatic failure; renal transplantation
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