HEPATITIS-C INFECTION IN RENAL-TRANSPLANT RECIPIENTS - EXPERIENCE ACQUIRED AT THE ENFANTS-MALADES-TEACHING-HOSPITAL (PARIS, FRANCE)

Since 1973, 925 renal transplants have been performed at the Pediatric Nephrology Department of the Enfants-Malades Hospital in Paris. Routi ne detection of hepatitis C virus infection using an ELISA for screeni ng and a RIBA for confirmation was started in 1990 in patients with fu nctioning transplants (n = 425) and was positive in 24% of cases (103/ 425). A PCR test for HCV-RNA was positive in 98 patients (93%) with po sitive serological tests; it was negative in five, indicating a remiss ion of the HCV infection. Eighteen patients had a documented history o f nonA-nonB hepatitis during the dialysis period. Possible sources of contamination in the other patients are the dialysis, the transplant, a blood transfusion, or nosocomial transmission. Mean age at contamina tion was estimated at 11 years, and mean follow-up was 11 years since contamination and nine years since transplantation. Clinical manifesta tions occurred in 28 patients, including acute hepatitis with jaundice , pruritus, hepatomegaly, portal hypertension, and asthenia. One patie nt developed a hepatocarcinoma after 20 years. Chronic cytolysis was f ound in 63 patients. Of the 41 patients who had a liver biopsy, seven had normal findings, two had acute hepatitis, 12 had moderate chronic hepatitis, six had active chronic hepatitis, and eight had cirrhosis. Some of the histologic lesions were not due to the HCV but rather to o ther viruses (CMV, EBV, HBV), to congenital abnormalities, to hemoside rosis, or to azathioprine toxicity. Cirrhosis was associated with a lo nger follow-up, and five patients with cirrhosis were also chronic car riers of the HBV. Antiviral therapy with interferon or ribavirin was u sed in a few patients, with poor results in terms of both efficacy and safety.