Clinical Hepatitis after transplantation of HCV Positive Kidneys
- HLA-DR3 as a risk factor for the development of PostTransplant
Hepatitis
Background.
Exposure to hepatitis C virus (HCV) and subsequent infection after
renal transplantation lead to significant clinical hepatitis in
approximately 50% of graft recipients,
Methods.
One hundred thirty-two consecutive renal allotransplant patients,
who underwent transplantation of kidneys from HCV-positive
cadaveric donors, were studied to investigate the relationship
between donor and recipient HLA type and the risk of developing
clinical hepatitis, Specific attention was directed toward the DR3
and DR4 alleles, as these had previously been associated with worse
prognoses in autoimmune and viral hepatitis.
Results.
Overall, 42% of patients receiving kidneys from donors seropositive
for HCV developed clinical hepatitis, This was unrelated to
preoperative recipient HCV serum reactivity (P=0.65). Patients
receiving kidneys from seropositive donors with HCV RNA as detected
by PCR were more likely to develop hepatitis than those receiving
kidneys from PCR-negative donors (56% vs. 11%; P=0.005), The
presence of the DR3 allele was associated with a significant risk
of clinical hepatitis (P=0.025); 80% of DR3-positive recipients
(n=34) progressed to hepatitis compared with 42% of DR3-negative
patients, No other recipient HLA type was significantly related to
prognosis. All patients receiving a donated kidney that expressed
the B41 allele developed hepatitis, compared with 55% of recipients
of non-B41 grafts (P=0.039). No association between the development
of clinical hepatitis and HLA compatibility was found.
Conclusions.
These results suggest that both HLA type and viral presence as
assayed by polymerase chain reaction, influence the risk. of
disease progression after transplantation of HCV-positive kidneys,
Application of these associations may decrease the relative risk of
a recipient contracting HCV hepatitis after cadaveric renal
transplantation.
Author: KIRK AD, UNIV WISCONSIN HOSP & CLIN, DIV
TRANSPLANTAT, CLIN SCI CTR H4710, 600 HIGHLAND AVE, MADISON, WI
53792
Source: TRANSPLANTATION 1996 DEC27;62(12):1758-1762
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