Five years experience in kidney transplantation (TX) of HCV positive recipients in Egypt

Abstract

The prevalence of HCV infection among chronic hemodialysis patients is around 85%. We present our follow-up experience for 21 HCV-antibody +ve patients transplanted for more than 5 years. Liver biopsy was done in 10 of these cases but no single case showed chronic active hepatitis. These patients were later found HCV RNA +ve by PCR. 20 HCV−ve Tx patients were included as control (C). All the 41 cases received their grafts from living donors. The two groups were matched in age, gender, etiology of renal disease, relation to donor, HLA matching, operative procedure and immunosuppression protocol (conventional triple therapy). The follow-up plan was that used by our institute. The immunosuppression protocol did not change in either group except on four occasions in the HCV+ve group and once in the C group.

The 1st year survival of both patient and graft was 90.5% in the HCV+ve group and 90% in the C group (P>0.05 in either). Five-year patient survival rate was 66.7% in the HCV+ve group and 70% in the C group (P>0.05), while graft survival was 66.7% vs 65% in the two groups respectively (P>0.05). Mortality was intimately related to liver cell failure in one case of either group, while the 6 other mortalities of the HCV+ve group were completely unrelated. Malignancy was reported in 3 cases of the HCV+ve group but not in the C group. Liver function tests were only mildly impaired in the HCV+ve group in comparison to the C group all through the five years of follow-up.

Conclusion: The results of this prospective study should encourage transplantation teams to perform Tx in HCV+ve patients, especially in Egypt, in view of the very high prevalence of HCV viremia. The rationale of preoperative liver biopsy will also be discussed.