RETROSPECTIVE STUDY ON THE IMPACT OF HEPATITIS-C VIRUS-INFECTION ON KIDNEY-TRANSPLANT PATIENTS OVER 20 YEARS

Background. The majority of chronic hepatitis is ascribable to hepatit is C virus (HCV) infection, whereas the clinical impact has not been u nderstood in kidney transplant recipients. Our current study was carri ed out to assess the impact of HCV infection on kidney recipients over the long-term, and to investigate the effect and risk of interferon-a lpha (IFN-alpha) therapy for chronic active hepatitis C, Methods. Hepa titis B surface antigen (HBsAg) and antibody to HCV (HCVAb) were exami ned prospectively and retrospectively in 280 patients, who underwent k idney transplants in the period from 1973 to 1996. The patient surviva l rate, the graft survival rate, the incidence of liver dysfunction an d the cause of mortality among the HCV infected and noninfected groups were analyzed. IFN-alpha! therapy was performed on 10 patients with c hronic active hepatitis C. Results. Prevalence of the hepatitis virus was quite high at 34.3% (96/280): the frequency of the HBsAg carrier w as 3.2% (9/280), that of the HCVAb carrier was 28.6% (80/280) and that of the both carriers was 2.5% (7/280). The other 184 cases (65.7%) we re negative for both HBsAg and HCVAb. Liver dysfunction developed at t he significantly higher incidence of 55% in HCVAb carriers compared to the 9.2% of the noninfected group (P<0.01), HCVAb carriers had a poor survival rate in the second decade compared to the noninfected group: 83.7% vs. 88.9% for 10-year survival(P=0.44) and 63.9% vs. 87.9% for 20-year survival(P<0.05), The poor survival rate was a result of the m ortality from liver disorder. Five patients died of such disease in th e infected groups whereas no noninfected patient died in the same peri od (p<0.01), As the result of IFN-alpha therapy, biochemical activity normalized or improved in eight cases, whereas the HCV-RNA titer was r educed only in three patients. Only one patient maintained normal bioc hemical markers and undetectable levels of HCV-RNA for 2 years after t reatment. The therapy was discontinued for five patients with the adve rse effects of acute rejection, deterioration of diabetes, and depress ion. Conclusions. HCV infection has a significant impact on kidney tra nsplant recipients over the long term and in particular affects them i n the second decade. Our pilot study revealed only partial efficacy of IFN-alpha therapy for HCV-infected recipients, but with the high risk of acute rejection.