Long‐term outcome in kidney transplant patients with hepatitis C (HCV) infection

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Abstract
To assess the prevalence and long‐term impact of HCV on kidney transplant recipients, we assayed 716 pre‐transplant sera using a firstgeneration ELISA. The anti‐HCV positive sera were confirmed by a 6‐ antigen radioimmunoassay (RIA). Patients were followed up for 5 years. Graft survival, function, evidence of chemical hepatitis (AST>2×normal), patient mortality and cause of death were evaluated. The prevalence of anti‐HCV antibody was 10.3%. In the 638 patients who were followed up for 5 years, there were no differences in graft function, graft survival, overall mortality, or death from sepsis or liver disease. Peak AST levels were significantly higher in anti‐HCV positive patients compared to anti‐ HCV negative patients. At 5 years, the AST levels remained significantly higher in the anti‐HCV positive group, however, this was only 6 U/l>normal. Liver biopsies performed 3 to 7 years post‐transplant in 80% of anti‐ HCV positive patients with chemical hepatitis showed 12% CAH, 50% mild hepatitis and 38% normal histology. Six (9.7%) patients seroconverted from anti‐HCV positive to anti‐HCV negative 2 to 5 years post‐transplant. The presence of anti‐HCV does not appear to alter long‐term patient or graft survival, and histologic evidence of severe chronic liver disease was rare in anti‐HCV positive patients with chemical hepatitis. From these results, the presence of anti‐HCV antibody should not preclude kidney transplantation.