HEPATITIS-C INFECTION IN POTENTIAL RECIPIENTS WITH NORMAL LIVER BIOCHEMISTRY DOES NOT PRECLUDE RENAL-TRANSPLANTATION

The hepatitis C virus (HCV) may be an important cause of chronic liver disease in renal transplant recipients. We investigated retrospective ly the incidence and outcome of HCV infection in long-term renal trans plant recipients and patients on hemodialysis. Stored, pretransplant s era of transplant recipients with normal liver biochemistry at surgery were tested for hepatitis C by a second-generation enzyme immunoassay . Hemodialysis patients were tested by a first-generation enzyme-linke d immunosorbent assay (ELISA) against c100-3. We studied 252 renal tra nsplant recipients and 58 hemodialysis patients followed for 65 +/- 10 months and 26 +/- 6 months, respectively. Fifteen percent (38/252) of the transplant recipients were HCV positive as were 3/58 (5%) of the hemodialysis patients. Overt liver disease occurred in 22/252 (8.7%) t ransplant recipients and none in the hemodialysis group. Thirty-six pe rcent (8/22) of transplant recipients with overt liver disease were HC V positive. No HCV-positive patients died of liver failure. Of six bio psies in the HCV-positive transplant group, two had histological evide nce of CAH. CAH was seen in six of eight biopsies in the HCV-negative transplants and two of these latter patients progressed to cirrhosis. No hemodialysis patients had clinical or histological evidence of chro nic liver disease. Two HCV-negative transplant patients died of liver failure, while no deaths related to liver disease occurred in hemodial ysis patients regardless of HCV status. We conclude that hepatitis C m ay cause chronic hepatitis in renal transplant patients. However, chro nic liver disease in HCV-positive renal transplant recipients appears to be a clinically and histologically benign entity. HCV-positive pote ntial renal allograft recipients with normal liver biochemistry should not be excluded from renal transplantation.