Clinicopathological features of rapidly progressive hepatitis C virus infection in HCV antibody negative renal transplant recipients

Background. Hepatitis C virus (HCV) infection acquired during dialysis trea tment generally shows a relatively benign course after renal transplantatio n (RTx). However, less is known about the course of HCV infection acquired during or after RTx. Methods. Clinical and histopathological assessment of 15 renal transplant r ecipients who acquired HCV infection during or after RTx. Results. Alanine aminotransferase levels rose for the first time 1-19 weeks after RTx. HCV RNA was found positive in all patients, but anti-HCV became positive in only nine of them. During a mean follow-up of 21 +/- 12 months , jaundice appeared in 12 patients while ascites and/or hepatic encephalopa thy occurred in six. Azathioprine was stopped in all patients. Cyclosporin was also stopped in four patients and in two of them prednisolone was also interrupted for a period of 3-7 weeks. Following this, ascites, hepatic enc ephalopathy and biochemical disturbances improved, while no deterioration w as seen in graft function. Nine of the 15 patients had undergone two consec utive liver biopsies (LB). The first LB revealed cirrhosis in three and chr onic hepatitis in six patients; the second LB showed cirrhosis in seven pat ients. The histological activity index (Knodell's score) progressed from 11 .8 +/- 3.5 to 13.8 +/- 3.8. Conclusions. The results suggest that HCV infection acquired during or afte r RTx may run an unusual and rapidly progressive clinical and histopatholog ical course at least in some of these patients. Decrease or withdrawal of i mmunosuppressive drugs may improve early hepatic failure without detrimenta l effect on graft function during that period.