LONG-TERM OUTCOME IN KIDNEY-TRANSPLANT PATIENTS WITH HEPATITIS-C (HCV) INFECTION

To assess the prevalence and long-term impact of HCV on kidney transpl ant recipients, we assayed 716 pre-transplant sera using a first-gener ation ELISA. The anti-HCV positive sera were confirmed by a 6-antigen radioimmunoassay (RIA). Patients were followed up for 5 years. Graft s urvival, function, evidence of chemical hepatitis (AST>2xnormal), pati ent mortality and cause of death were evaluated. The prevalence of ant i-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 le vels were significantly higher in anti-HCV positive patients compared to anti-HCV negative patients. At 5 years, the AST levels remained sig nificantly higher in the anti-HCV positive group, however, this was on ly 6 U/l>normal. Liver biopsies performed 3 to 7 years post-transplant in 80% of anti-HCV positive patients with chemical hepatitis showed 1 2% CAH, 50% mild hepatitis and 38% normal histology. Six (9.7%) patien ts seroconverted from anti-HCV positive to anti-HCV negative 2 to 5 ye ars post-transplant. The presence of anti-HCV does not appear to alter long-term patient or graft survival, and histologic evidence of sever e chronic liver disease was rare in anti-HCV positive patients with ch emical hepatitis. From these results, the presence of anti-HCV antibod y should not preclude kidney transplantation.