COMPLICATIONS - INFECTIONS

P. Pascual núñez¹, S. Sanz ballesteros², A. Mendiluce herrero¹, V. Perez diaz¹, J. Bustamante bustamante^1
1Nephrology, Hospital Clinico Universitario, valladolid/SPAIN, ²Nephrology, Hospital Clinico Universitario, Valladolid/SPAIN

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INTRODUCTION The prevalence of infection by the hepatitis C virus (HCV) in kidney transplant patients has diminished in the last few years (2.4-6%). Infection has a negative influence on the survival of the transplant and the patient; it represents the main cause of hepatic dysfunction in transplant patients and the fourth in terms of mortality, increasing the risk of post-transplant Diabetes Mellitus (PTDM), infectious disease and glomerular nephritis (GN). The evolution of hepatic disorders depends on the development of cirrhosis and its complications. Hepatic fibrosis, the initial stage of cirrhosis, determines the prognosis of hepatic disease. Although biopsy remains the preferred diagnostic technique, the last years have seen the development of non-invasive methods that measure the degree of fibrosis; fibroscan is one such technique. AIMS To carry out a retrospective evaluation of HCV positive transplant patients in our unit between 1995 and 2009. MATERIAL AND METHODS A retrospective observational study of HCV positive kidney transplant patients in our unit from 1995 to 2009. An analysis was made of the survival of both the patient and the transplanted kidney, the evolution of renal function, the extent to which the liver was affected by means of fibroscan, and the appearance of extra-hepatic complications. RESULTS We observed an HCV prevalence of 3.56% (18 patients). The majority (61.1%) were second or third transplant cases with a high immunological risk. The most common genotype was 1b. Immunosuppression was by induction with basiliximab plus triple therapy: steroids, tacrolimus and mycophenolate mofetil. All the patients had normal hepatic function when transplantation commenced. The pre-transplantation viral rate was negative (22%). The survival of the patient was 100% and that of the graft 77.9% (follow-up median: 42 months; range 2-139 months). 50% of the causes of graft loss were associated with HCV by GN. Mean creatinine was 1.38 mg/dl with MDRD 4 de 51.17 ml/min/1.73m. Three patients presented with nephritic proteinuria. None of the patients showed serious liver complications, and there were only four cases of fluctuations in transaminases. The results of the fibroscan were as follows: 58% moderate fibrosis of the liver (Fo-F1). Kpa <7.6; 27% significant fibrosis (F2-F3) and only one compatible with cirrhosis Kpa >22.5 (F=4). In terms of extra-hepatic complications: 2 patients developed membranous GN causing graft loss and 1 thrombotic microangiopathy (currently at stage IV CRD). 2 presented with PTDM (13%); we had no serious infectious complication. CONCLUSIONS The prevalence of positive HCV in our series was similar to that found in other studies. The appearance of proteinuria represented a bad prognosis for the survival of the kidney graft. We had no serious infectious or hepatic complications, and there was concordance between the results obtained by fibroscan and clinical evolution. The use of fibroscan in the follow-up of kidney transplant patients with hepatitis C may be useful in the future to assess the evolution of kidney disease. Consequently, biopsy will in many cases prove unnecessary.

Disclosure: All authors have declared no conflicts of interest.