HISTOLOGICAL EVOLUTION OF HEPATITIS C VIRUS INFECTION AFTER RENAL TRANSPLANTATION

Background: information regarding histological progression of hepatitis C after renal transplant (RTx) is scarce. Aims: To analyze clinical and laboratory evolution and histological progression of hepatitis C in patients evaluated before and after RTx. Methods: Twenty-two HCV-infected patients submitted to liver biopsy pre- and post-RTx were included. A semiquantitative analysis of necroinflammatory activity and fibrosis staging was performed and the two biopsies were compared. Results: Patients were mostly men (73%) with mean age of 36 +/- 9 yr. Time post-transplant was 4 +/- 2 yr and time between biopsies was 5 +/- 2 yr. An elevation of alanine aminotransferase (p = 0.041) and aspartate aminotransferase (p = 0.004) levels was observed in the post-transplant period. Fibrosis progression after renal transplantation was observed in 11 (50%) of the patients, and necroinflammatory activity worsening was observed in 7 (32%) of the patients. The histological progression occurred even among those without significant histological lesions in pre-transplant biopsy. Conclusion: The findings of this study suggest that the practice of indicating treatment in the pre-transplant phase based mainly on histological disease should be revised, because a high proportion of patients present disease progression. Because interferon cannot be used safely after RTx, treatment should be indicated for all ESRD patients with hepatitis C.