The acquisition time of infection: a determinant of the severity of hepatitis C virus-related liver disease in renal transplant patients

Abstract: Background: The aim of this study was to compare the clinical and histopathological course of HCV infection acquired before and during or after renal transplantation. Methods: According to HCV status, 197 RT patients were divided into three groups. At the time of RT, anti‐HCV antibody was positive in 47 patients (pre‐RT HCV group). In 27 patients, in whom anti‐HCV negative at the time of RT, anti‐HCV and/or HCV RNA was found to be positive following an ALT elevation episode after RT (post‐RT HCV group). Both anti‐HCV and HCV RNA were negative at all times in remaining 123 patients (control group). Results: Liver biopsy was performed in 31 of 47 patients in pre‐RT and 24 of 27 in post‐RT HCV group after RT. Duration of follow‐up was similar in all groups with a mean of 7.1 ± 4.0 yr. Ascites and encephalopathy were seen in only post‐RT HCV group (22%). Histological grade (6.5 ± 2.7 vs. 4.1 ± 1.4) and stage (2.0 ± 1.5 vs. 0.8 ± 0.8) was significantly severe in post‐RT HCV group (p < 0.01). Three patients died due to liver failure in post‐RT HCV group. Conclusions: HCV infection acquired during or after RT shows a severe and rapidly progressive clinicopathological course, which is significantly different from pre‐transplant anti‐HCV positive patients.