Hepatitis C Related Glomerulonephritis: A Growing Cause of Renal Failure After Liver Transplantation

Abstract

183 Liver transplantation OLTX is an effective treatment resulting in long term survival of most recipients. Progressive renal failure after OLTX has long been felt to be due to CYA or Tacrolimus (TAC). Since many patients have been transplanted for HCV or develop it after transplantation, the risk of HCV related GN developing has increased with improved patient survival. We report our experience with GN after OLTX and concentrate on the contribution of HCV to post OLTX GN. We have retrospectively collected data on patients referred to the transplant nephrology service for evaluation of nephrotic syndrome and rising creatinine. Records were available on 89 patients. Increasing creatinine was the most common reason for referral and nephrotic syndrome in the remainder. Renal biopsy was not feasible in 42 patients due to advanced renal failure or coagulopathy but was performed in 47 patients. HCV serology was available in 39 of these. HCV related GN was noted in 12(46%) of HCV+ patients and 30.8% of all biopsied patients with GN. FSGS was the most frequently encountered diagnoses in all patients. Classic finding of CYA or TAC toxicity was unusual as the major histologic finding. In HCV+ and HCV- patients progression to end stage renal disease is predictable given the natural history of the biopsy findings. Treatment with steroids or cytotoxic agents was not attempted if patients were found to be HCV+ since such treatment may exacerbate their HCV hepatitis. Non-immunologic measures directed at delaying progression of renal failure, and reduction in immunosuppression appears to be the appropriate approach to HCV+ patients. Several patients without HVC may have benefited from the anti-proteinuric effects of TAC. In summary, HCV related GN was a major contributor to glomerular disease after OLTX. Referral of OLTX patients GN should be made early to improve the chances of preventing or delaying progressive renal failure. CYA or TAC are unusual causes of renal failure in this setting.Table