OBJETIVE: To demonstrate that chronic infection with the hepatitis C virus (HCV) is a risk factor for the development of transplant glomerulopathy in a large sample of kidney biopsies analyzed by electron microscopy, and to demonstrate its negative impact on graft survival.

METHODS: Retrospective analysis, all biopsy samples of renal grafts with the diagnosis of chronic graft dysfunction, conducted between 2000 and 2014 in Madrid at 12 de Octubre Hospital were collected. 229 in total. Those in which histological study was carried out immunofluorescence (IF) and electron microscopy (EM) were selected. The work was divided in two phases: Firstly, a case control study: samples from 119 patients with chronic graft dysfunction were collected and the presence for HCV and Transplant Glomerulopathy (TG) was assessed. Secondly, a retrospective cohort study: samples from patients with TG diagnosed by EM and IF were collected.

RESULTS: In the sample of 119 patients with chronic graft dysfunction diagnosed by ME there were no differences in the immunological characteristics of patients with and without TG. HCV was a risk factor for developing TG with an OR=7.20 (2.47 to 21.01). No significant association was found of C4d, DSA, anti-HLA and history of acute rejection, with the TG, although it is evident the DSA as a risk factor for GT with an OR = 1.71 (1.06 to 2, 76). An error of type b for low power of the sample can explain the absence of this association. Patients with chronic graft dysfunction and HCV + showed significantly worse graft survival than the HCV-.

All patients who presented ultrastructural diagnosis of TG (57) were divided into two cohorts based on status for HCV. Significant differences between HCV+ / HCV- patients concerning the presence of interstitial fibrosis and tubular atrophy degree of the samples were found, being higher in the HCV+ patients. TG+ HCV+ patients significantly showed worse graft survival.

CONCLUSIONS: Chronic HCV infection is a risk factor for transplant glomerulopathy diagnosed by electron microscopy, showing a lower graft survival after diagnosis by biopsy, and even lower when associated with HCV+, being this the longest published series of renal grafts with TG diagnosed by ME.

CITATION INFORMATION: Regidor D, Alexandru S, Martínez M, Polanco N, González E, Serrano A, Morales J. Chronic Infection by Hepatitis C Virus and the Development of Transplant Glomerulopathy. Am J Transplant. 2016;16 (suppl 3).

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