Prevalência e incidência da hepatite C em pacientes submetidos a transplante renal

OBJECTIVE: To detect the prevalence and the seroconversion of the anti-HCV in renal transplants, while evaluating the presence of this antibody at the time of thetransplant, and during a 1-year follow-up, as well as the possibility of transmitting the disease to the recipient of the contaminated organ.PATIENTS AND METHODS: We investigated the prevalence of anti-HCV infection in 48 kidney transplant recipients, and also in their respective donors. Serumspecimens were collected from the organ recipients right before kidney transplant, and 6 and 12 months after transplant; serum specimens were collected from donors at the time of nephroctomy. The 192 samples were stored at -20º C. The anti-HCV tests used were commercial kits based on synthetic HCV peptides (UBI), enzygnost anti-HCV (Boehringer), and Abbot HCV EIA 2nd generation. In patients with a positive anti-hepatitis C UBI test, the presence of HCV-RNA was verified by polymerase chain reaction .RESULTS: Eleven of 40 patients had positive UBI results, and 12 of 48 had positive EIA anti-HCV results before the transplant. Sixteen patients were anti-HCV positive during the 1-year follow-up. Two patients became positive after 6 months, and one after 12 months. One of these patients was also HCV-RNA positive. No transplant recipient patient with positive anti-HCV before transplant seroconverted after 1 year. Fifty percent of the patients who received a kidney were HCV-RNA positive. Three of 40 donors indicated a positive anti-HCV antibody in the UBI test, and 4 of 48 donors indicated a positive anti-HCV antibody in the Boehringer and EIA tests. Two donors were HCV-RNA positive.CONCLUSIONS: The prevalence of anti-HCV before transplant was high, and the serconversion to positive was low during the follow-up; none of the anti-HCV positive patients seroconverted; the HCV-RNA positive patients did not change to negative after transplant, which indicates the persistence of viral replication even after immunosupression; anti-HCV positive donors, even in the presence of HCV-RNA, did not transmit the infection during 1 year after transplant.OBJETIVO: Investigar a prevalência do anti-VHC em 48 receptores renais e seusrespectivos doadores.PACIENTES E MÉTODOS: Foi coletado sangue dos receptores pré-transplante, 6meses e 1 ano pós-transplante; e dos doadores, no momento da nefrectomia. As192 amostras foram conservadas a -20 °C. Os testes anti-VHC utilizados forampeptídeos sintéticos (UBI) e ELISA de segunda geração (Abbott). Nos pacientescom positividade ao anti-VHC pelo teste UBI, foi pesquisado o VHC-ARN por reaçãoem cadeia da polimerase.RESULTADOS: Onze de 40 receptores foram anti-VHC positivos pelo teste da UBIe 12 de 48 pelo teste da Abbott pré-transplante. Dezesseis pacientes apresentarampositividade ao anti-VHC no período de 1 ano pós-operatório. Dois positivaram aos6 meses e um em 1 ano. Um deles apresentou positividade também ao VHC-ARN.Nenhum paciente anti-VHC positivo seroconverteu com 1 ano de seguimento.Verificou-se a presença do VHC-ARN em 50% dos receptores renais. Três de 40doadores foram anti-VHC positivos pelo teste UBI e 4 de 48 pelo teste Abbott. Doisdoadores apresentaram positividade ao VHC-ARN.CONCLUSÕES: 1) A prevalência do anti-VHC pré-transplante foi alta, porém aseroconversão para anti-VHC positivo no seguimento de 1 ano foi baixa; 2) nenhumpaciente anti-VHC positivo seroconverteu; 3) houve manutenção da positividadeao VHC-ARN demonstrando persistência da replicação viral apesar daimunossupressão; 4) os doadores anti-VHC positivos, mesmo com a presença doVHC-ARN não transmitiram a infecção através do enxerto renal no seguimento de1 ano pós-operatório