HEPATITIS-C ANTIBODY AFTER KIDNEY-TRANSPLANTATION - CLINICAL-SIGNIFICANCE

The prevalence of antibodies to hepatitis C virus (HCV) was investigat ed in 231 renal transplantation recipients, by a first- and second-gen eration EIA assay and a second-generation immunoblot assay (4-RIBA). B efore transplantation, prevalence of anti-HCV was 22.6% and was relate d to the time on dialysis (p < 0.01), transfusions (p < 0.01) and prev ious history of chronic liver disease (p < 0.01. Following transplanta tion, 32 patients (13.9%) were anti-HCV positive by the first-generati on enzyme immunoassay (EIA) and it increased to 57 patients (24.7%) wh en anti-HCV was measured by the second-generation EIA. The 4-RIBA assa y confirmed the positivity in 46 patients (80.7%), 11 patients (19.3%) were indeterminate. Seroconversion after grafting was observed in 7 n egative patients, and another 7 patients became negative after the pro cedure. The presence of anti-HCV antibody after transplantation was de termined by the patient status on dialysis, 80% of them being positive before surgery. Twenty-one 4-RIBA-positive transplantation patients ( 45.7%) had persistently or intermittently abnormalities on liver funct ion tests, suggesting chronic liver disease. A liver biopsy performed on 10 of these patients showed; chronic active hepatitis in 6, chronic persistent hepatitis in 2, and chronic lobular hepatitis in the other 2 patients. Another 23 4-RIBA-positive transplantation patients had n ormal alanine aminotransferase levels despite long follow-up (66.2 +/- 32.2 months). The prevalence of anti-HCV antibody can be underestimat ed if the antibody is measured by first-generation EIA alone. About 50 % of patients with anti-HCV had chronic liver disease, and the histolo gical findings suggested a possible evolution to cirrhosis. The signif icance of the coexistence of anti-HCV and normal function test needs f urther evaluation.