Prevalence of hepatitis c virus-associated mixed cryoglobulinemia after liver transplantation

Hepatitis C virus (HCV) infection is associated with mixed cryoglobulinemia and membranoproliferative glomerulonephritis, After orthotopic liver trans plantation (OLT), isolated cases of HCV-associated mixed cryoglobulinemia h ave been reported. We determined the prevalence and clinical characteristic s of mixed cryoglobulinemia in HCV-infected liver transplant recipients at our institution. Between January 1991 and February 1998, a total of 191 OLT s were performed in 178 patients. Among these transplant recipients, 53 pat ients (29.8%) had positive serological test results for HCV infection by se cond-generation enzyme-linked immunosorbent assay. We studied 31 HCV-positi ve (HCV+) and 21 HCV-negative (HCV-) transplant recipients (control group). Renal and liver function studies were performed, and cryoglobulin, rheumat oid factor, C3, C4, and serum HCV RNA levels and genotype were determined. Results were compared using unpaired Student's t-test for continuous variab les and Fisher's exact test for categorical variables. Baseline characteris tics were similar between the groups, Six patients in the HCV+ group (19%) had mixed cryoglobulins present at the time of evaluation compared with non e in the HCV- group (P =.036). The only parameter associated with cryoglobu lins in the HCV+ group was rheumatoid factor (P <.01). In 3 HCV+ patients w ith cryoglobulins, extrarenal signs of cryoglobulinemia were present. Glome rulonephritis was found in 4 HCV+ patients. Two patients with purpura and c ryoglobulinemia had reduced clinical manifestations after antiviral therapy . In conclusion, mixed cryoglobulinemia was found in approximately 20% of t he HCV+ liver transplant recipients. The presence of purpura or glomerulone phritis suggests HCV-associated mixed cryoglobulinemia, a clinical syndrome that may respond favorably to antiviral therapy. Copyright (C) 2000 by the American Association for the Study of Liver Diseases.