Natural history of hepatitis b and/or c in renal graft recipients

O99* Aim: In order to study the natural history of hepatitis C and/or B in renal graft recipients, 284 infected patients with long-term functioning graft were prospectively studied from 1989 when the HCV antibody (antiHCV) was first tested in all pts, transplanted between 1972–1989. Methods: In all patients HBsAg was tested at transplantation (tx) whereas antiHCV (by ELISA II) from 1989, in all pts after tx. Results: At enrollment, at 1989, (62±44 months after tx) 208 patients were antiHCV positive (HCV+), 41 patients HbsAg positive (HBV+) and 35 patients were both HBV+ HCV+ (HCV+HBV+). 104 patients were receiving azatioprine (AZA) and transplanted since 10±3 years (range 24–214 months), whereas 180 patients were on cyclosporine A (CsA) and transplanted since 3.6±1.6 years (range 0–80 months). The mean follow-up was 19±6 years in AZA-treated patients and was 13±5 years in CsA-treated patients. Table 1FigureLiver biopsy (fig.1) showed chronic active hepatitis(CAH) in 73 pts, cirrhosis 20 pts and fibrosing cholestatic hepatitis (FCH) in 2 pts. 23 out of 37 pts in whom liver biopsy was repeated, showed a progression of liver disease. Causes of death are reported in table1. Death related to liver disease occurred in 13% of patients. Even if the 18-year patient survival did not differ significantly among the 3 groups of patients, death related to liver disease tended to be more frequent, although not significantly, in the carriers of virus B (with or without HCV+), being 22% in HBV+, 9% in HCV+ and 23% in HBV+HCV+ patients, after 11.8±5.4, 13.8±6.8, 12.4±6.0 years respectively. Death related to liver disease occurred after 8.5±3.6 years in CsA and 17.5±5 years in AZA treated patients (p=0.0001). In conclusion, in the long-term HBV+ patients had a higher risk of death related to liver disease than HCV+ patients, coinfection did not worsen patient survival. Death related to liver disease occurred significantly earlier in CsA- than in AZA-treated patients. Hepatocarcinoma was more frequent in patients on AZA, probably because of the longer follow-up.