Outcome of hepatitis C virus-associated membranoproliferative glomerulonephritis after liver transplantation

Background Hepatitis C virus was the most frequent cause of liver failure r equiring liver transplantation in our series. Hepatitis C virus infection h as been associated with glomerulonephritis and, more frequently, type I mem branoproliferative glomerulonephritis, Renal disease in patients with liver failure is often clinically silent and difficult to diagnose; thus, biopsy is required to establish the diagnosis. Our aim was to study the evolution of six patients diagnosed with membranoproliferative glomerulonephritis so me months before liver transplantation. Methods, Liver transplantation alone was performed in four patients and com bined liver-kidney transplantation in the remaining two, who were on hemodi alysis for kidney failure. These patients mere followed for a mean of 38.3/-7.8 months. Evolution of proteinuria, renal function, hepatic function, a nd hepatitis C virus activity was studied. Results. In the four patients who underwent liver transplantation alone, pr oteinuria became negative initially and renal function remained stable. Pro tein-uria reappeared and renal function was altered in two of these patient s at 17 and 36 months of follow-up, respectively, coinciding with a recurre nce of active chronic hepatitis. In the two patients who received a combine d liver-kidney transplant, proteinuria became negative, and their renal gra fts currently maintain normal renal function. Conclusions. Membranoproliferative glomerulonephritis does not constitute a n absolute contraindication for liver transplantation alone; combined liver -kidney transplantations are reserved for patients with end-stage kidney fa ilure, Proteinuria is reversed after liver transplantation, and recurrence seems to be associated with severe hepatitis C virus hepatic allograft dise ase relapse.