IMMUNOSUPPRESSIVE THERAPY AND HEPATITIS-C VIRUS-INFECTION - THE CLINICAL COURSE OF LIVER-DISEASE

In a retrospective long-term follow-up study the clinical course of li ver disease was examined in renal allograft recipients with hepatitis C virus (HCV) infection and negative hepatitis B surface antigen under immunosuppressive therapy. We compared 42 anti-HCV antibody (anti-HCV ) positive patients (study group) to 213 anti-HCV negative patients (c ontrol group). All patients received immunosuppressive therapy. Measur ements were made of the following: aminotransferases, bilirubin, album in, gammaglobulins, ascites, spleen diameter, HCV RNA, and anti-HCV an tibody. We found all but four anti-HCV positive patients to be HCV RNA positive prior to transplantation. There were no differences in overa ll mortality or mortality secondary to liver disease or sepsis. Normal liver enzymes were found in 13 (31%) anti-HCV positive and in 137 (64 %) anti-HCV negative patients during the whole mean observation period of 65 months (range 10-215). Aminotransferase activity decreased in a nti-HCV positive and negative pa tients during the observation period. Liver function with regard to synthesis and excretion was normal in a nti-HCV negative and anti-HCV positive patients. No signs of portal hy pertension were observed in the anti-HCV positive group. Neither the d ifferent immunosuppressive regimens nor the antirejection therapy led to differences between anti-HCV positive and negative groups with resp ect to liver function and did not alter the clinical course. We conclu de that HCV infection in patients un der immunosuppressive therapy cau ses only a mild liver disease, as determined by clinicochemical and cl inical parameters, and that mortality rate is not increased.