The Course And Predictor(s) Of Hepatitis C Virus Associated Liver Disease In Long-Term Survivors of Kidney Transplantation: The Role Of Viral Genotype And Viral Load

K Al Meshari; T Chaurdy; O Alfurayh; W Qunibi; K Al Shaibani; E De Vol, King Faisal Specialist Hospital and Research Centre, Saudi Arabia

HCV is the most common cause of chronic liver disease in renal transplant recipients (RTR). The purpose of the current investigation was to study the course and predictor(s) of advanced liver disease in long-term survivors ( ³ 5 years) of kidney transplantation (KT) who were infected with HCV at or prior to KT. Fifty-four HCV infected RTR who were HBsAg and HIV nonreactive were studied. There were 31 males and 23 females; average age was 42 ± 12; 23/54 (43%) received a cadaveric kidney; and 34/54 (63%) were on triple immunosuppressive regimen. All patients were HCV RNA positive by PCR. HCV genotype (HCVG) analysis by line probe assay (LiPA) or restriction fragment length polymorphism (RFLP) revealed the following genotypes/subtypes:

1a

1b

3a

4

6

Mixed

(n = 54)

11

17

4

17

1

4

After a mean follow-up of 10 years (range: 5-20), all patients except two were alive. Forty of 54 (74%) patients developed chronic hepatitis (CH). Thirty of 40 (75%) patients with CH underwent a liver biopsy; two had cirrhosis (stage 4); 5 had near cirrhosis (stage 3); 7 had focal bridging fibrosis (stage 2); and the remaining 16 patients had stage 1 liver disease. Seven patients had hemosiderosis (HS). Using stages 3 and 4 as dependent variables, conventional univariate and log Xact univariate and multivariate analyses were applied to identify an association or predictor(s) of the above stages in the following independent variable: age, sex, transplant type, induction immunosuppression, CH, duration of CH, maintenance immunosuppression, HS, diabetes mellitus, HCVG, and HCV RNA load by branched DNA assay (bDNA). Among the tested independent variable, only age was statistically significant (p = 0.028).

Conclusion: In long-term survivors of kidney transplantation with HCV infection: 1] HCV associated liver disease is slowly progressive. 2] The advanced stage of liver disease is neither genotype specific nor does it correlate with viral load, it does, however, correlate with advanced age.