RENAL-DISEASE IN HEPATITIS C-POSITIVE LIVER-TRANSPLANT RECIPIENTS

Glomerular abnormalities are frequent in patients undergoing liver tra nsplantation; however, renal dysfunction following transplantation is mainly attributed to cyclosporine toxicity, Membranoproliferative glom erulonephritis (MPGN) is seen in patients infected with hepatitis C vi rus (HCV), the virus responsible for 30% of the end-stage liver diseas e leading to liver transplantation. To determine the incidence of rena l abnormalities in liver transplant recipients and the association wit h HCV, we undertook a longitudinal study in HCV-positive (n=91) and HC V-negative (n=106) liver transplant recipients, Mean creatinine cleara nce before transplantation was 94 ml/min/1.73 m(2) in HCV+ patients an d 88 ml/min/1.73 m(2) in HCV-patients, By 3 months after transplantati on, the mean creatinine clearance decreased by approximately one third in both groups, A greater proportion of HCV+ patients excreted >2 g p rotein/day after transplantation (P=0.05) and had renal biopsies showi ng MPGN than did HCV- recipients (4/10 HCV+ patients vs, 0/7 HCV- pati ents; P=0.1), In the HCV+ group, proteinuria was not associated with r ecurrent HCV hepatitis, DQ matching, posttransplant diabetes, or hyper tension, Treatment of HCV-related MPGN with interferon-alpha 2b appear ed to stabilize proteinuria and renal function but did not reverse ren al dysfunction nor cause liver allograft rejection, After transplantat ion, HCV+ patients had similar renal function over 3 years after trans plantation, compared with HCV- patients, but they had an increased ris k of proteinuria and occurrence of MPGN that was only partially respon sive to interferon.