Natural history of hepatitis B and C in renal allograft recipients

Adriana Aroldi, Pietro Lampertico, Giuseppe Montagnino, Patrizia Passerini, Margherita Villa, Maria R. Campise, Giovanna Lunghi, Antonio Tarantino, Bruno M. Cesana, PierGiorgio Messa, Claudio Ponticelli

Research output: Contribution to journalArticlepeer-review

Abstract

Background. In renal allograft recipients, most cases of liver dysfunction are caused by hepatitis B virus and hepatitis C virus (HCV). The natural history of hepatitis C and B was studied in 286 renal allograft recipients who received a kidney allograft between 1972 and 1989 when tests for anti-HCV became available. Methods. In all patients, hepatitis B (HB) surface (s) antigen (Ag) was tested before and anti-HCV (by enzyme-linked immunosorbent assay II) after transplantation. Results. At enrollment in 1989 (5.5±4 years after transplantation), 209 patients were anti-HCV positive (C+), 42 patients were HBsAg-positive (B+), and 35 patients were both B+ and C+ (C+B+). One hundred four patients were receiving azathioprine (AZA) and 182 were on cyclosporine A (CsA). Since transplantation, the median follow-up was 18 years in AZA-treated and 13 years in CsA-treated patients. Liver biopsy showed chronic hepatitis in 73 patients, cirrhosis in 20 patients, and fibrosing cholestatic hepatitis in 2 patients. In 34 patients, liver biopsy was repeated, and progression of fibrosis was observed in 24 patients. The 12-year patient survival rate was similar in B+,C+, and B+C+ patients (67%, 78%, and 71%, respectively; P=not significant). Liver-related death was the first cause of death in B+ and B+C+ infected patients (58% and 72%, respectively), whereas cardiovascular disease was the leading cause of death in C+ patients (40%). Multivariate analysis showed that older age (>40 years) (relative risk [RR], 2.8), B+ status (RR, 2.36), and C+ status (RR, 1.65) were independently associated with a worse patient survival. Conclusions. In the long term, B+ patients had a higher risk of death related to liver disease than C+ patients, and co-infection did not worsen patient survival.

Original languageEnglish
Pages (from-to)1132-1136
Number of pages5
JournalTransplantation
Volume79
Issue number9
DOIs
Publication statusPublished - May 15 2005

Keywords

  • Chronic hepatitis
  • Hepatitis B virus
  • Hepatitis C virus
  • Renal transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology

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