HBV and HCV infections in heart transplant recipients.

BACKGROUND: Heart transplant (HTx) recipients risk acquiring hepatotropic viral infections such as hepatitis B virus (HBV) and hepatitis C virus (HCV), and the impact of these infections on post-HTx survival remains unclear. The aim of the present study was to define the prevalence, clinical features, and natural history of HBV and HCV infections in a cohort of HTx recipients. METHODS: We retrospectively studied 360 consecutive patients who had undergone HTx. Clinical picture, hepatic injury indexes, and HBV/HCV viral serology were followed post-transplant. RESULTS: During follow-up (average, 8 +/- 3.1 years), 49 (16.5%) of the HTx recipients tested positive for at least 1 of the 2 viruses (3.1% HBV, 12% HCV, 0.5% concomitant infection). The prevalence of HCV infection in heart transplant recipients transplanted before and after 1990 was 28% and 4.2%, respectively, the latter being markedly lower (p < 0.001) than in earlier series of HTx recipients and much lower than expected in the age- and sex-matched general population. All HBV-positive and 58% of HCV-positive recipients developed chronic liver disease. Sixteen percent of patients developed cirrhosis during follow-up, and 8% died of end-stage liver disease. CONCLUSIONS: The prevalence of HBV and HCV in a large population of HTx recipients is not very different from that reported in the general population. Active viral replication of HBV and an aggressive natural history of both infections are seen in HTx recipients, however. The low prevalence of HBV- and HCV-related infection in recent series probably reflects current viral screening and vaccination policies.     

Natural leukocyte interferon alfa for the treatment of chronic viral hepatitis in heart transplant recipients

BACKGROUND: A more rapid and aggressive course of hepatitis B virus (HBV)-related and hepatitis C virus (HCV)-related infection in organ transplant recipients has been described. Interferon alfa is the most accepted drug for treating HBV and HCV chronic infections. However, the use of interferon alfa-N3 has been contraindicated in heart transplant (HTx) recipients because of the hypothesized greater risk of triggering acute cellular rejection. The aim of this clinical pilot study was to evaluate tolerability, safety, and efficacy of natural leukocyte interferon alfa in the treatment of chronic HBV and HCV in HTx recipients. METHODS: Seven HTx recipients were enrolled in the study: two with HBV, four with HCV, and one with combined HBV-HCV chronic infection. The patients had a mean follow-up after heart transplantation of 8.5+/-3 years, before starting interferon alfa-N3 treatment at a dose of 6 MU three times per week, intramuscularly for 12 months. RESULTS: All patients completed the treatment with no major side effects. No unexpected episodes of acute cellular rejection were observed during the treatment. Mean aminotransferase serum levels were significantly lower than before transplantation at 3 (P<0.03), 6 (P<0.02), and 12 (P<0.02) months of treatment and at the 12-month follow-up (P<0.02). A complete and sustained response was achieved in all subjects with HBV-related chronic hepatitis, whereas sustained virologic response was observed in one of four HCV patients. CONCLUSIONS: The preliminary data emerging from our study indicate that natural leukocyte interferon alfa-N3 can be safely administered in HTx recipients with chronic HBV or HCV viral hepatitis. Further studies with larger numbers of patients are needed to assess the efficacy of interferon alfa-N3 on HCV virologic response.     

Hepatitis serology predicts tumor and liver-disease characteristics but not prognosis after resection of hepatocellular carcinoma

The impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection on survival rates after resection of hepatocellular carcinoma (HCC) is controversial. The objective of this study was to determine whether serologic evidence of HBV or HCV infection ("hepatitis serology") can predict underlying liver disease, tumor factors, and survival rates in patients with HCC. Using a multicenter international database, we identified 446 patients with complete HBV and HCV serology. One hundred twenty-six patients were negative for HBV and HCV, 163 patients had HBV infection only, 79 patients had HCV infection only, and 78 patients had coinfection with HBV and HCV. Patients with hepatitis were more likely to have tumors smaller than 5 cm and bilateral HCC involvement. Hepatitis status (negative vs. HBV vs. HCV vs. coinfection with HBV and HCV) did not predict tumor grade or the presence of multiple tumor nodules. Patients with HCV or coinfection with HBV and HCV exhibited a lower incidence of vascular invasion, but worse fibrosis than patients with negative serology or HBV. The median survival rate was 47.9 months. The presence of hepatitis did not significantly affect the survival rate, but hepatic fibrosis and vascular invasion predicted a decreased survival rate. The prognosis after resection of HCC is influenced by tumor factors and liver disease, but not by HBV or HCV infection. The treatment for HCC should be dictated by the extent of underlying liver disease rather than by hepatitis serology. Presented at the Forty-Fifth Annual Meeting of the Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004 (oral presentation).     

Liver transplantation for alcoholic cirrhosis with anti-HCV antibodies

The results of orthotopic liver transplantation (OLT) in patients with alcoholic liver cirrhosis (ALC) are currently similar to those obtained in patients with other indications. However, the frequent association of ALC with hepatitis C virus (HCV) infection may impair these results. We retrospectively studied the consequences of HCV infection on survival and graft function in 59 patients with ALC undergoing OLT. Patients were classified into two groups depending on their HCV serology before transplantation: group 1 comprised 24 anti-HCV-positive patients, and group 2, 35 anti-HCV-negative patients. Patient and graft survival were similar in both groups. Liver function tests 1 and 4 years after OLT showed AST and ALT values that were significantly higher in group 1 patients and post-transplant histologically proven chronic hepatitis was found in 45 % and 61 % of these patients at 1 and 4 years, respectively. We conclude that pretransplant HCV infection in patients with ALC does not affect survival after OLT. However, one must bear in mind the high incidence of post-transplant chronic hepatitis secondary to recurrence of HCV infection and be cautious when drawing this conclusion. Received: 1 October 1996 Received after revision: 3 March 1997 Accepted: 17 March 1997     

Blood-borne viruses in the haemodialysis-dependent population attending Top End Northern Territory facilities 2000-2009

Aim: To describe the incidence and prevalence of blood‐borne viruses (BBV) including: hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) and human T‐cell leukaemia virus type‐1 (HTLV) in the haemodialysis‐dependent population of the Top End of the Northern Territory (TENT). Methods: We retrospectively reviewed the serology of BBV in a longitudinal fashion in the haemodialysis‐dependent population treated in the TENT of Australia from 2000 to 2009 inclusive. HBV, HCV, HIV and HTLV serology on commencement of dialysis and at exit or January 2010, whichever was earlier, as well as demographic details were collected. Patients with a change in serological status had all serology reviewed. Results: Four‐hundred and forty patients were included in the analysis. Of these, 84.3% were Indigenous and 55.4% female, with a median age of 50 (IQR 43–59) years at the commencement of haemodialysis. Evidence of past HBV infection was documented in 42.7% and 8.9% were hepatitis B surface antigen‐positive. Positive serology for HTLV was documented in 2.2%, 1.6% were hepatitis C antibody‐positive and no individual was HIV‐positive. Three patients had a definite change in their HBV serology over time; this equates to an absolute seroconversion risk of 0.1 per 100 person years or 0.0006 per dialysis episode. Conclusions: In this cohort, there was a high rate of past and current hepatitis B infection but low rates of seroconversion while on haemodialysis.     

Heart transplantation using donors positive for hepatitis

From May 1994 to September 2003, 177 hearts were procured for heart transplantation (HTx) from donors ranging in age from 1 year 2 months to 66 years 5 months (mean = 30 years). All donors and recipients received serologic tests for hepatitis B surface antigen (HBsAg) and antibody (anti-HBs), and hepatitis C virus antibody (anti-HCV). Thirty-two donors were HBsAg-positive and another four were anti-HCV-positive. Two HBsAg-positive donors were transplanted to patients with no previous evidence of hepatitis. After HTx, one received hepatitis B immunoglobulin prophylaxis and no hepatitis was noted during a 5 years follow-up. The other seroconverted at 4 months after HTx, requiring lamivudine treatment. Another four HBsAg-positive donors were transplanted to HBsAg-positive recipients. All four recipients had hepatitis flare-ups requiring lamivudine treatment. The other 26 HBsAg-positive donors were transplanted to anti-HBs-positive recipients. None suffered from hepatitis. Among the four patients receiving anti-HCV-positive hearts, seroconversion was noted in one recipient at 26 months. This patient never had clinical hepatitis before he died of allograft rejection at 3 years after HTx. The other three recipients remain anti-HCV negative during follow-up of 80, 50, and 46 months. It was concluded the hepatitis B- or C-positive donors could be used as heart donors for status 1 patients. Donors with positive HBsAg may be transplanted to anti-HBs-positive recipients with no HBV infection.     

Evidence that clearance of hepatitis C virus RNA after alpha-interferon therapy in dialysis patients is sustained after renal transplantation

To date, there is no available treatment of hepatitis C virus (HCV) infection after renal transplantation (RT). Among 55 anti-HCV-positive/HCV RNA-positive hemodialysis patients who were treated with IFN-alpha (9 MU/wk during 6 or 12 mo), 21 of them (38%) had a sustained virologic response. Of these, 16 (76%) underwent RT 38 mo (range, 2 to 57 mo) after alpha-IFN therapy. There were 13 men and 3 women aged 46 yr (range, 27 to 68 yr). At RT, HCV serology was still positive in 15 patients, and HCV viremia was negative in all patients. Immunosuppression relied on anticalcineurin agents with or without steroids and/or antimetabolites; in addition, 12 of them received induction therapy with antithymocyte globulins. At the last follow-up after RT, at 22.5 mo (range, 2 to 88 mo), HCV viremia remained negative in all patients. Moreover, HCV RNA was not present in peripheral blood mononuclear cells when assessed in eight patients. HCV serology was found to be still positive in 13 patients. Three patients presented with acute rejection, one presented with a suppurative lymphocele, one died from a sepsis, and four presented with a cytomegalovirus infection. None of them developed posttransplant diabetes mellitus. In conclusion, hemodialysis patients waiting for a RT need to be treated with alpha-IFN because when HCV RNA clearance occurred, they experienced no relapse after transplantation despite chronic immunosuppressive treatment.     

胆管癌与肝炎病毒感染相关性研究

目的:调查胆管癌患者血清中肝炎病毒标志物检出率,探讨胆管癌发生与肝炎病毒感染的相关性.方法:收集天津地区11年间3所医院305例胆管癌的临床资料,统计其中肝炎病毒感染率和肝炎病毒危险因素接触状况,调查住院期间血清肝炎病毒标志物检出情况.调查了同期住院的480例良性胆道疾病患者作为对照.结果:胆管癌和良性胆道疾病患者既往乙型肝炎病毒(HBV)感染率分别为3%和2.5%;29%的胆管癌病例可以检出HBV的血清标志物,而良性胆道疾病病例HBV血清标志物的检出率为21%,二者有显著差异.丙型肝炎病毒(HBV)的血清标志物检出率在胆管癌为4.3%,在良性胆道疾病为5.6%,二者比较无差别.结论:胆管癌患者中并发HBV感染率较高,HBV感染与胆管癌的发生可能存在一定的关系.由于HCV的检测指标单一,目前尚不能排除胆管癌发生与HCV感染无关.     

维持性血液透析患者丙型肝炎病毒感染情况的调查与护理预防

目的 调查本透析中心6年间维持性血液透析患者丙型肝炎病毒的感染率变化情况,分析丙型肝炎病毒感染的易感因素,探讨预防丙型肝炎病毒传播的措施.方法 检测所有长期维持性血液透析患者丙型肝炎抗体,丙型肝炎RNA,并收集相关临床资料.结果 2004年155例透析患者中丙型肝炎感染率为10.3%.2009年228例患者中丙型肝炎抗体阳性率为8.8%.2010年300例丙型肝炎的感染率为7.3%.其中111例患者在我中心透析6年以上,累计透析85100余次,没有新发丙型肝炎感染.显示输血次数和肾移植病史是并发丙型肝炎的危险因素.结论 近6年来我中心的血液透析患者丙型肝炎感染率呈下降趋势.通过减少输血,严格执行血液透析时防止血源性传播疾病操作规程,能够减少丙型肝炎在透析患者之间的传播.

Abstract：

Objective To investigate the hepatitis C virus (HCV) infection in patients with maintained hemodialysis for 6 years in the hemodialysis center of Beijing Friendship Hospital, and to analyse the risk factor of HCV infection. Methods HCV RNA , the serum virus antibody were detected in hemodialysis patients . The relationship between the infection of hepatitis virus and the dialysis time, blood infusion and hepatic function was analysed. Results The percentage of HCV infection patients was 10.3% ,8.8%, and 7.3% in 2004,2009,2010 respectively. 111 patients were treated in our center for more than 6 years. There was no new HCV infection in these group patients during 6 years. Blood infusion and the history of kidney implantation were the risk factors. Conclusion The percentage of HCV infection in hemodialysis patients was reduced in our dialysis center. Avoidance blood transfusion and infection control of blood purification standard operating procedure are the major ways to prevent transmit HCV in patient with MHD.     

Hepatitis B or C virus serology as a prognostic factor in patients with hepatocellular carcinoma

It is not clear whether chronic hepatitis B or C virus (HBV or HCV) infection is a prognostic factor for hepatocellular carcinoma. We performed this study to determine if chronic HBV or HCV infection had any impact on postresection survival or affected patterns of failure. The records of 77 patients undergoing surgical resection for hepatocellular carcinoma between January 1990 and December 1998 were reviewed. Forty-four patients (57%) had HCV infection, 18 patients (23%) had HBV infection, and 15 patients (20%) had negative serology. There were no differences in age, sex, or tumor size among the groups, and all patients had margin-negative resections. There was a significantly higher incidence of satellitosis and vascular invasion in patients with HCV infection (32 % and 41 %, respectively; P <0.05 vs. other groups). With a median follow-up of 30 months, a significantly decreased local disease-free survival (LDFS) was seen in HBV-positive (5-year LDFS 26%) or HCV-positive (S-year LDFS 38%) patients compared to those with negative serology (S-year LDFS 79%; P <0.05). There was also a trend toward a decreased overall survival in patients with positive hepatitis serology compared to patients with negative serology (37% vs. 79%; P = 0.12). Uuivariate analysis revealed that only satellitosis was related to local recurrence and overall survival. Patients with positive serology for hepatitis B or C undergoing resection for hepatocellular carcinoma have a trend toward worse overall prognosis and a significantly decreased LDFS when compared to patients with negative serology. Presented at the Forty-First Annual Meeting of The Society for Surgery of the Alimentary Tract (Ross Research Conference), San Diego, Calif., May 21–24, 2000.     

Occupational risk of hepatitis B and C infections in urologists.

The purpose of this study is to evaluate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and the related risk factors among urologic surgery patients and urologists. This cross-sectional, prospective study included 300 consecutive urologic surgery patients and 24 urologists working in our department. The patients and urologists with positive serology for any of the hepatitis viruses were questioned for risk factors including previous transfusions, surgery, endoscopy, intravenous drug abuse and homosexuality. Positive serology for HBV and/or HCV was found in 47.4% of the patients, and the rate of the patients with antigenemia, the major risk group for the urology team, was 9.9%. Of the 24 urologists working in our department, 3 were antibody to HCV (anti-HCV) positive and 2 were hepatitis B surface antigen (HBsAg) positive. The presence of a risk factor among patients with HBsAg was found in 78.9% and in 100% of those with anti-HCV. The prevalence of hepatitis in urologic surgery patients and urologists is poorly described. This study indicates a high prevalence of HBV and HCV seropositivity in urology patients. In urology wards, the risk of hepatitis transmission is estimated to be appreciably high because of the renal transplantation procedure and frequent use of blood and blood-contaminated solutions for transurethral resections or catheter irrigations. Vaccination with HBV vaccine and application of universal precautions during daily practice seem to be the only and most effective means of protection against blood-borne infections.     

Heart Transplantation for Chagas Cardiomyopathy in the United States

Since an initial case in 2006, we noted multiple patients undergoing heart transplantation (HTx) for Chagas cardiomyopathy (CC) at our transplant program. The clinical characteristics, laboratory results and outcomes of patients with CC undergoing HTx in the United States have not been reported previously. In 2010, we implemented a systematic screening and management program for patients undergoing HTx for CC. Before HTx, all patients with idiopathic dilated cardiomyopathy who were born in a Chagas disease endemic country were screened for Trypanosoma cruzi (TC) infection with serology. After HTx, monitoring for TC reactivation was performed using clinical visits, echocardiography, endomyocardial biopsy and serial whole blood polymerase chain reaction (PCR) testing. Between June 2006 and January 2012, 11 patients underwent HTx for CC. One patient was empirically treated due to the presence of TC amastigotes in explanted cardiac tissue. Two patients experienced allograft dysfunction due to TC reactivation and three patients experienced subclinical reactivation (positive PCR results), which were treated. Chagas disease is a common cause of dilated cardiomyopathy in patients from endemic countries undergoing HTx at a transplant program in the United States. Reactivation is common after transplantation and can cause adverse outcomes.     

Hepatitis C virus and death risk in hemodialysis patients

In maintenance hemodialysis (MHD) patients, hepatitis C virus (HCV) infection is common and may be associated with poor clinical outcomes. It was hypothesized that HCV infection would be associated with high all-cause and cardiovascular mortality in these patients after controlling for demographic and clinical characteristics, including surrogates of malnutrition-inflammation complex syndrome. A national database of 13,664 MHD patients who underwent HCV antibody serology testing at least once during a 3-yr interval (July 2001 through June 2004) was analyzed. Measurements included third-generation HCV enzyme immunoassay and routine laboratory measurements. The HCV enzyme immunoassay was reported positive in 1590 (12%) patients. In logistic regression models that included case mix and available surrogates of malnutrition-inflammation complex syndrome, HCV infection was associated with younger age, male gender, black race, Hispanic ethnicity, Medicaid insurance, longer dialysis vintage (duration), unmarried status, HIV infection, and smoking history. In proportional-hazards regressions, the mortality hazard ratio that was associated with HCV infection was 1.25 (95% confidence interval 1.12 to 1.39; P < 0.001). Mortality hazards were higher among incident (dialysis duration <6 mo) than prevalent HD patients. Subgroup analyses indicated that HCV was associated with higher all-cause and cardiovascular mortality across almost all clinical, demographic, and laboratory groups of patients. Hence, in MHD patients, HCV infection exhibits distinct demographic, clinical, and laboratory patterns, including associations with higher dialysis treatment vintage, and is associated with higher mortality. More diligent efforts to prevent and treat HCV infection may improve outcomes in MHD patients.     

Heart transplantation in the patient under ventricular assist complicated with device-related infection

Ventricular assist devices (VAD) have benefited patients with end-stage heart failure as a bridge to heart transplantation (HTx). We present our experience of HTx in the presence of device-related infection (DRI) including driveline exit site with pocket infections. From May 1996 to April 2003, mechanical circulatory support with the HeartMate VAD was performed in eight patients, and with the Thoratec VAD in seven patients. Although 151 patients underwent HTx during that period, only 8 of the 15 patients had suitable donors and underwent orthotopic HTx. Six of the eight patients developed DRI. Their ages ranged from 18 to 59 years (mean = 36 +/- 14 years). The duration of VAD support ranged from 8 to 287 days (mean = 125 +/- 117 days). The general condition and cardiac function improved gradually under VAD support. At the time of HTx, all six male patients were suffering from DRI. The causative microorganisms were Acinetobacter baumannii (n = 3) methicillin-resistant Staphylococcus aureus (n = 2), and Enterococcus faecium (n = 1). All patients underwent successful HTx, and were discharged in good condition. It is concluded that under the coverage of appropriate antibiotics, HTx can be successfully performed for the patients for VAD support with DRI. It is important to prevent the spread of infection during HTx. Adequate debridement and drainage of the infected materials prevents postoperative wound infections.     

Lymphoproliferative disorders in heart transplant recipients: role of hepatitis C virus (HCV) and Epstein‐Barr virus (EBV) infection

Abstract Post‐transplant lymphoproliferative disorders (PTLD) are a well known complication after orthotopic heart transplantation (OHT). Although Epstein‐Barr virus (EBV) infection has long been implicated in the pathogenesis of such disorders, other factors may play a part. Because of its lymphotropic properties, hepatitis C virus (HCV) may induce clonal expansion of B‐lymphocytes and lead to PTLD. The aim of this study was to evaluate the potential association between HCV and EBV infection and PTLD in OHT patients. The retrospective study considered 404 adult patients screened for HCV. EBV serology, histology, and molecular analysis on tissue biopsies were performed in the PTLD patients (10/404, 2.5%). HCV positivity was found in 36/404 (8.9 %) patients. The EBV genome was expressed on all neoplastic tissue samples analyzed. A higher proportion of HCV‐positive patients developed PTLD than the HCV‐negative cases (8 % vs 2%, P = 0.017). EBV has a demonstrated role in the onset of PTLD, but HCV infection probably has to be considered as well.     

Factors predicting 10-year survival after heart transplantation.

BACKGROUND: We sought to identify factors predictive of long-term (>10-year) survival in heart transplant (HTx) recipients. METHODS: Four hundred fifteen adult patients underwent HTx at our institution between August 1982 and May 1997. The 158 patients who survived >10 years (Group A) and the 116 patients who died between 2 and 6 years (Group B) of HTx were compared in terms of gender, gender mismatch, ethnicity, age, height, weight, United Network for Organ Sharing status, type of induction therapy (OKT3 or anti-thymocyte globulin), infections (bacterial, viral, fungal and protozoal), cytomegalovirus (CMV) status, CMV mismatch, diabetes mellitus, hypertension and incidence of rejection episodes and transplant coronary artery disease within 2 years of HTx. RESULTS: Group A (135 men, 23 women; mean age 48 +/- 11 years) had significantly fewer post-HTx rejection episodes and viral, bacterial, fungal and total infections than did Group B (95 men, 21 women; mean age 49 +/- 12 years). Group A also had a significantly lower mean donor age, a lower incidence of pre-HTx diabetes, and a lower mean cholesterol level 1 year after HTx. In a multivariate analysis, fewer bacterial infections and rejection episodes after HTx, the absence of pre-HTx diabetes, and lower donor age were associated with longer survival. CONCLUSIONS: Pre-HTx diabetes, donor age and incidences of infection and rejection within 2 years of HTx predict long-term (>10-year) survival. Better control of infection and rejection during the first 2 years after HTx may improve survival.     

Estimated Risk of Human Immunodeficiency Virus and Hepatitis C Virus Infection among Potential Organ Donors from 17 Organ Procurement Organizations in the United States

To prevent unintentional transmission of bloodborne pathogens through organ transplantation, organ procurement organizations (OPOs) screen potential donors by serologic testing to identify human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. Newly acquired infection, however, may be undetectable by serologic testing. Our objective was to estimate the incidence of undetected infection among potential organ donors and to assess the significance of risk reductions conferred by nucleic acid testing (NAT) versus serology alone. We calculated prevalence of HIV and HCV—stratified by OPO risk designation—in 13 667 potential organ donors managed by 17 OPOs from 1/1/2004 to 7/1/2008. We calculated incidence of undetected infection using the incidence‐window period approach. The prevalence of HIV was 0.10% for normal risk potential donors and 0.50% for high risk potential donors; HCV prevalence was 3.45% and 18.20%, respectively. For HIV, the estimated incidence of undetected infection by serologic screening was 1 in 50 000 for normal risk potential donors and 1 in 11 000 for high risk potential donors; for HCV, undetected incidence by serologic screening was 1 in 5000 and 1 in 1000, respectively. Projected estimates of undetected infection with NAT screening versus serology alone suggest that NAT screening could significantly reduce the rate of undetected HCV for all donor risk strata.     

Long-term outcome of hepatitis C virus infections acquired after pediatric liver transplantation

The outcomes and characterization of hepatitis C virus (HCV) infections after pediatric liver transplantation (LT) have rarely been reported. We describe our experience with HCV infections after pediatric LT. Ten of 207 children (4.8%) who underwent LT at our institution (1985-2010) developed previously undiagnosed HCV disease. Eight received a liver graft before blood product and donor screening for HCV became available. The mean age at transplantation was 8.9 ± 4.3 years, and the median time from transplantation to the diagnosis of HCV was 15.1 years (range = 0.2-19.7 years). The genotypes were 1 (n = 8), 3 (n = 1), and undetermined (n = 1). At the time of this writing, all the patients were still alive with a mean follow-up of 7.3 ± 5.5 years after the diagnosis of HCV. Five patients did not receive treatment; 2 of these patients achieved spontaneous viral clearance (SVC). Four of the 5 treated patients achieved a sustained virological response, and 3 had an early virological response (EVR). Two of these 4 patients developed chronic rejection while they were on treatment, but this was resolved with a conversion from cyclosporine A to tacrolimus. The remaining patient was continuing treatment and had achieved EVR. In conclusion, despite the limitations of our series, de novo HCV infections after pediatric LT seem to have a slow histological progression. Even with genotype 1, the patients have a good long-term prognosis and respond well to treatment. Nevertheless, chronic rejection during antiviral therapy may develop. In addition, SVC may occur in this population.     

Impact of hepatitis C virus infection on patient and graft survival in kidney transplantation

Hepatitis C virus (HCV) infection is the main cause of chronic liver disease after renal transplantation, which represents a risk factor for graft loss and patient death. Hepatitis C (+) kidney transplant candidates who remain on the waiting list show a greater risk of mortality than those who are transplanted, a risk that escalates with time. The aim of this study was to examine the impact of HCV infection on patient and allograft survival in our transplant population. Among 90 renal transplant patients transplanted between 1991 and 2002 who were retrospectively analyzed, 45 were HCV-positive and 45 HCV-negative by serology. All positive patients had shown positive HCV antibody and/or positive HCV RNA. The mean ages of the patients were 36.2 +/- 9 years among the HCV (+) and 38 +/- 10 years among the HCV (-) patients (P = .31). Eighteen HCV (+) patients and 14 HCV (-) patients received their grafts from deceased donors. The immunosuppressive protocols were similar in both groups. The number of acute rejection episodes were 13 (30%) in HCV (+) and 6 (13%) in the HCV (-) group (P = .006). Diabetes mellitus developed in 10 (23%) HCV (+) and 7 (16%) HCV (-) patients (P = .04). Cytomegalovirus disease occurred in 5 (16%) HCV (+) and 2 (6%) HCV (-) patients (P = .32). The mean serum creatinine was 1.85 +/- 1.1 mg/dL in HCV (+) and 1.8 +/- 1 mg/dL in HCV (-) group (P = .82). The mean graft survivals were 97.1 +/- 52 months in the HCV (+) and 81.1 +/- 37 months in the HCV (-) group (P = .04). Seven HCV (+) patients (16%) and three HCV (-) patients (6%) lost their grafts (P = .04). Advanced cirrhosis developed in three HCV (+) patients (6%). One patient died in the HCV (+) group. Patient survivals were 98% in the HCV (+) and 100% in the HCV (-) cohorts. In this study, the rate of graft loss was higher in HCV (+) patients, whereas the patient survival was similar.