EFFECT OF CHRONIC HEPATITIS C INFECTION ON LYMPHOCYTE SUBSETS IN RENAL TRANSPLANT PATIENTS

Abstract

Chronic hepatitis C (HCV) infection is prevalent in renal allograft recipients. Consequently, this group is more likely to develop liver complications and have poorer graft outcome. The interaction between viral and host factors under immunosuppressive therapy is important in highlighting the response to HCV infection after renal transplantation. The aim of this study was to assess changes that occur in the lymphocyte subsets of HCV‐infected kidney recipients, and to determine how these relate to allograft rejection. We investigated 50 patients (33 males and 17 females; mean age 32.0±9.9years; mean time since transplantation: 27.6±26.5months) who were receiving standard immunosuppressive therapy. Data concerning acute or chronic allograft rejection were retrieved from the patients' records. Lymphocyte subsets (CD4, CD8, CD3, CD19, CD16–56), serum albumin levels, and anti‐HCV positivity were evaluated after renal transplantation, and findings in the HCV‐positive and ‐negative groups were compared. Seven of the 50 patients had HCV infection. Anti‐HCV positivity was detected before transplantation in three cases, and these patients received interferon therapy before transplantation. Four patients were found to be HCV positive after transplantation. The anti‐HCV (+) patients had significantly lower serum albumin (P<0.02), lower CD4/CD8 (P<0.02) ratios, and a lower percentage of CD 19 (P<0.001) and a higher percentage of CD8 (P<0.01) cells. Chronic allograft rejection was observed in 71.4% of the HCV‐positive patients (P<0.04), whereas no acute rejection was detected in this group. The findings indicate that HCV infection may alter the immune response in renal transplant recipients, and that the immunogenic potential of the virus may be higher in this patient group because of low serum albumin levels. It appears that this immunomodulatory action and low albumin levels may increase the risk of chronic rejection for HCV‐infected kidney recipients.