PREDICTORS OF GBV-C INFECTION AMONG PATIENTS REFERRED FOR RENAL-TRANSPLANTATION

The etiology of liver disease remains unknown in about 4 to 23% of dia lysis patients and 10 to 16% of renal transplant recipients. A search for other causative agents of liver disease led to the discovery of th e GB group of viruses. We studied the association between the presence of GB virus C (GBV-C) infection, known risk factors for parenterally- transmitted infections and history or laboratory evidence of liver dis ease among end-stage renal disease (ESRD) patients referred for renal transplantation to the New England Organ Bank, MA. Stored sera from pa tients on the renal transplantation waiting list between November 1986 and June 1990 were tested for antibody to hepatitis C virus (HCV). Se ra were available in 1544 of 3243 (48%) patients, and anti-HCV was det ected by ELISA3 in 287 (19%). All 287 anti-HCV positive patients forme d the anti-HCV positive cohort and 286 randomly selected anti-HCV nega tive patients formed the anti-HCV negative cohort (573 patients overal l). Additional sera were available for GBV-C RNA testing in 465 of 573 (81%) patients, and GBV-C RNA was detected by RT-PCR in 146. The over all extrapolated prevalence of serum GBV-C RNA was 29%. The prevalence of serum GBV-C RNA among anti-HCV positive patients (35%) was not sig nificantly different from that among anti-HCV negative patients (29%; P = 0.22). In a univariate analysis, compared to patients without GBV- C RNA, patients with serum GBV-C RNA were younger [odds ratio (OR) 0.9 8 per year of age, P = 0.01], had a lower proportion of males (OR 0.64 , P = 0.03), lower proportion of patients with diabetes mellitus (OR 0 .44, P = 0.01), higher proportion of patients with a previous transpla ntation (OR 1.53, P = 0.04), longer duration of dialysis at the time o f enrollment (OR 1.004 per month on dialysis, P = 0.03), and a higher proportion of patients with history of transfusions (OR 4.58, P = 0.01 ). Serum GBV-C RNA was not associated with a significantly increased O R for history of liver disease or non-A, non-B hepatitis, or elevated serum alanine aminotransferase levels. In a step-wise multivariate reg ression analysis, a younger age (OR 0.98 per year of age, P = 0.03), a nd history of blood transfusions (OR 3.89, P = 0.03) were associated w ith an increased OR for serum GBV-C RNA, while diabetes mellitus was a ssociated with a decreased OR for GBV-C RNA (OR 0.47, P = 0.01). Anti- HCV was not a predictor of serum GBV-C RNA (OR 1.07, P = 0.77). The re sults of this study support the fact that GBV-C is a parenterally tran smitted virus and shed light on the modes of transmission of GBV-C amo ng ESRD patients. However, the association with liver disease remains to be established.