HEPATITIS-C VIRUS-INFECTION IN RENAL-TRANSPLANT RECIPIENTS - EPIDEMIOLOGY, CLINICAL IMPACT, SEROLOGICAL CONFIRMATION AND VIRAL REPLICATION

The presence and significance of hepatitis C virus infection was evalu ated in 241 renal transplant recipients from our hospital. Hepatitis C virus antibodies were tested by second-generation enzyme immunoassay, followed by second- and third-generation immunoblot assays (RIBA-2 an d RIBA-3); hepatitis C virus RNA was measured by nested polymerase cha in reaction. Hepatitis C virus antibodies, which were detected in 46.5 % of patients, were mainly present before transplantation and independ ently associated with the total amount of transfused blood, time in he modialysis and duration of posttransplant follow up. Liver dysfunction (alananine aminotransferase elevation) was observed in 50% of antibod y-positive recipients, and 92.5% of patients whith chronic liver disea se without hepatitis B infection were infected with hepatitis C virus. Most antibody-positive patients (78.4%) tested positive by RIBA-2, bu t 21.6% were indeterminate; RIBA-3 was positive in 90% of these indete rminates. Hepatitis C virus RNA detection was positive in 96% of antib ody-positive cases tested, in 20% of patients who were already anti-HC V negative before transplantation and also demonstrated persistence of HCV infection in all cases who, being antibody positive prior to tran splantation, lost these antibodies during follow up (9% of transplante d patients). In conclusion, hepatitis C virus infection is extremely p revalent in renal transplant recipients from Spain and is the main cau se of chronic liver disease in these patients. Confirmation by supplem ental assays of anti-HCV antibodies is not necessary but hepatitis C v irus RNA testing is indispensable to detect those cases who lose or do not develop hepatitis C virus antibodies.