EVOLUTION OF THE HYPERVARIABLE REGION-1 OF HEPATITIS C VIRUS AND LIVER FIBROSIS PROGRESSION IN RENAL-TRANSPLANT RECIPIENTS

Abstract

P793 Aim: The aim of our study was to assess hepatitis C virus (HCV) evolution and liver histology outcome in HCV(+)/RNA(+) renal-transplant (RT) patients. Methods: A total of 55 patients (34 men, 21 women, median age 38 years) underwent serial liver biopsies (LB) after transplantation (2 LB, n=11; 3 LB, n=35; 4 LB, n=9). The median times between transplantation and the first LB was 30 (9−145) months. The median time between two consecutive biopsies was 37 months. Results: Overall, the rate of liver fibrosis progression per year, defined as the ratio of the difference in fibrosis stage between two consecutive LBs and the time between these two biopsies, was 0.07 ± 0.03 Metavir units/year. We identified three groups of patients: those in whom liver fibrosis remained stable (group I, n=21), those with progressing liver fibrosis (group II, n=21, 0.34 ± 0.05 units/year), and those with a regression in liver fibrosis (group III, n=13, −0.25 ± 0.24 units/year). In the last two groups, the progression and the regression of liver fibrosis were progressive during follow-up. Demographic data, immunosuppressive treatment, the duration of HCV infection, HCV genotype, as well as liver enzyme (AST and ALT) levels, renal parameters, and HCV RNA concentrations before transplantation and at each LB, were similar in all groups. After transplantation, ALT only increased significantly in group II. In contrast, AST and HCV viremia increased significantly in all groups. At the third LB, ferritin levels and hepatosiderosis were significantly higher in group II compared with the other groups. Overall, liver activity scores were similar in the three groups. Sequence analysis of the hypervariable region-1 of the HCV genome revealed a significantly lower diversification between transplantation and the first biopsy in patients with stable or progressing liver fibrosis compared with those with regressing liver fibrosis. Conclusion: In conclusion, after renal transplantation, HCV infection is not harmful upon liver fibrosis in all patients. Sequencing of the hypervariable region-1 of HCV might predict the long-term liver histology outcome.