Brief Communication: Glomerulonephritis in Patients with Hepatitis C Cirrhosis Undergoing Liver Transplantation

16 May 2006 | Volume 144 Issue 10 | Pages 735-741

Background: Patients infected with hepatitis C virus (HCV) frequently develop renal failure after liver transplantation.

Objective: To describe renal histologic characteristics and concomitant clinical features in HCV-infected patients with end-stage cirrhosis.

Design: Case series.

Setting: Single-center liver transplant program in the United States.

Patients: 30 patients who received liver transplants for HCV-induced cirrhosis.

Intervention: Kidney biopsy during liver engraftment.

Measurements: Clinical data and laboratory tests of renal function within 6 months before liver transplantation.

Results: Twenty-five patients had immune-complex glomerulonephritis: membranoproliferative glomerulonephritis type 1 (n = 12), IgA nephropathy (n = 7), and mesangial glomerulonephritis (n = 6). Of these patients, 10 had normal serum creatinine levels, normal urinalysis results, and normal quantitative proteinuria. For 5 others, the only renal abnormality was an increased serum creatinine level. No patient had cryoglobulins in the blood or kidney.

Limitations: This small observational study did not include patients with nonviral cirrhosis and did not document post-transplantation outcomes.

Conclusions: Immune-complex glomerulonephritis was common in patients with end-stage HCV-induced cirrhosis and was often clinically silent. Its potential to cause renal failure after liver transplantation may be underappreciated.

Editors' Notes Context We do not know why some patients infected with hepatitis C virus (HCV) develop renal failure after liver transplantation. Contribution This case series describes 30 patients who had kidney biopsies during liver engraftment for HCV-induced cirrhosis. Twenty-five had immune-complex glomerulonephritis. Of these, 10 had normal serum creatinine levels, urinalysis results, and urinary protein excretion and none had blood or kidney cryoglobulins. Cautions Investigators did not study clinical outcomes after transplantation. Implications Clinically silent immune-complex glomerulonephritis occurs in patients with end-stage HCV-induced cirrhosis. We do not yet know whether it can lead to renal failure after liver transplantation. —The Editors

 

Author and Article Information

From University of Alabama at Birmingham, Birmingham, Alabama.

Note: A preliminary report of this study was submitted to the American Association for the Study of Liver Diseases 56th Annual Meeting and Postgraduate Course, San Francisco, California, 11-15 November 2005.

Acknowledgments: The authors thank Mrs. Pamela R. Davis and Mrs. Leila L. Avant for assistance in compilation of the data, Dr. Britt B. Newsome for assistance in analysis of the data, Dr. Jan Novak for his insight on immune complexes and renal disease, and Drs. Michael B. Fallon and Joseph R. Bloomer for editorial suggestions.

Grant Support: By Roche Pharmaceuticals, Inc.

Potential Financial Conflicts of Interest: Grants received: B.M. McGuire (Roche Pharmaceuticals, Inc.), S.J. King (Roche Pharmaceuticals, Inc.), D.E. Eckhoff (Roche Pharmaceuticals, Inc.); Honoraria: B.M. McGuire (Roche Pharmaceuticals, Inc.).

Requests for Single Reprints: Brendan M. McGuire, MD, MS, University of Alabama at Birmingham, 1530 Third Avenue South, MCLM 262A, Birmingham, AL 35294-0005; e-mail, bmcguire{at}uab.edu.

Current Author Addresses: Dr. McGuire: University of Alabama at Birmingham, 1530 Third Avenue South, MCLM 262A, Birmingham, AL 35294-0005.

Drs. Julian and Curtis: University of Alabama at Birmingham, 1530 Third Avenue South, THT 643, Birmingham, AL 35294-0006.

Dr. Bynon: University of Alabama at Birmingham, 1530 Third Avenue South, LHRB 722, Birmingham, AL 35294-0007.

Dr. Cook: University of Alabama at Birmingham, 1530 Third Avenue South, KB 603, Birmingham, AL 35294-7331.

Dr. King: University of Alabama at Birmingham, 1530 Third Avenue South, MCLM 274, Birmingham, AL 35294-0005.

Dr. Accortt: Cancer Prevention Institute, 601 West Riverview Avenue, Dayton, OH 45406.

Dr. Eckhoff: University of Alabama at Birmingham, 1530 Third Avenue South, LHRB 710, Birmingham, AL 35294-0007.

Author Contributions: Conception and design: B.M. McGuire, B.A. Julian, J.S. Bynon Jr., W.J. Cook, J.J. Curtis, D.E. Eckhoff.

Analysis and interpretation of the data: B.M. McGuire, B.A. Julian, W.J. Cook, N.A. Accortt.

Drafting of the article: B.M. McGuire, B.A. Julian, W.J. Cook.

Critical revision of the article for important intellectual content: B.M. McGuire, B.A. Julian, J.S. Bynon Jr., W.J. Cook, S.J. King, J.J. Curtis, N.A. Accortt, D.E. Eckhoff.

Final approval of the article: B.M. McGuire, B.A. Julian, J.S. Bynon Jr., W.J. Cook, S.J. King, J.J. Curtis, N.A. Accortt, D.E. Eckhoff.

Provision of study materials or patients: B.M. McGuire.

Statistical expertise: B.M. McGuire, N.A. Accortt.

Obtaining of funding: B.M. McGuire, J.S. Bynon Jr., D.E. Eckhoff.

Administrative, technical, or logistic support: B.M. McGuire.

Collection and assembly of data: B.M. McGuire, J.S. Bynon Jr., W.J. Cook, S.J. King, D.E. Eckhoff.