No evidence of occult hepatitis C virus (HCV) infection in serum of HCV antibody-positive HCV RNA-negative kidney-transplant patients

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http://www3.interscience.wiley.com/journal/123210514/abstract

Transplant International

Volume 23 Issue 6, Pages 594 - 601

Published Online: 11 Dec 2009

Journal compilation © 2010 ESOT

ORIGINAL ARTICLE

No evidence of occult hepatitis C virus (HCV) infection in serum of HCV

antibody-positive HCV RNA-negative kidney-transplant patients

Florence Nicot 1,2 , Nassim Kamar 3,4,5 , Bernard mé 1 , Lionel Rostaing

1,3,4 , Christophe Pasquier 1,2,3 and Jacques Izopet 1,2,3

1 INSERM, U563, Toulouse, France

2 Department of Virology, CHU Toulouse, Purpan Hospital, Toulouse, France

3 Université Toulouse III -Sabatier, Centre de Physiopathologie de

Toulouse Purpan, Toulouse, France

4 Department of Nephrology, Dialysis and Multiorgan Transplantation, CHU

Toulouse, Rangueil Hospital, Toulouse, France

5 INSERM, U858, Toulouse, France

Correspondence to Prof. Jacques Izopet, Laboratoire de Virologie, Institut

Fédératif de Biologie, CHU Toulouse, 330 avenue de Grande-Bretagne, TSA40031,

Toulouse 31059, France. Tel.: 33 5 67 69 04 24; fax: 33 5 67 69 04 25; e-mail:

izopet.j@...

Copyright Journal compilation © 2010 ESOT

ABSTRACT

Persistence of hepatitis C virus (HCV) in patients who cleared HCV is still

debated. Occult HCV infection is described as the presence of detectable HCV RNA

in liver or peripheral blood mononuclear cells (PBMCs) of patients with

undetectable plasma HCV-RNA by conventional PCR assays. We have assessed the

persistence of HCV in 26 kidney-transplant patients, followed up for 10.5 years

(range 2–16), after HCV elimination while on hemodialysis. If HCV really did

persist, arising out of the loss of immune control caused by institution of the

regimen of immunosuppressive drugs after kidney transplantation, HCV

reactivation would have taken place. Their immunosuppression relied on

calcineurin inhibitors (100%), and/or steroids (62%), and/or antimetabolites

(94%). An induction therapy, given to 22 patients, relied on rabbit

antithymocyte globulin (59%) or anti-IL2-receptor blockers (32%). All patients

had undetectable HCV RNA as ascertained by several conventional tests. At the

last follow-up, no residual HCV RNA was detected in the five liver biopsies, the

26 plasma, and in the 37 nonstimulated and 24 stimulated PBMCs tested with an

ultrasensitive RT-PCR assay (detection limit, 2 IU/ml). No biochemical or

virologic relapse was seen during follow-up. The absence of HCV relapse in

formerly HCV-infected immunocompromised patients suggests the complete

eradication of HCV after its elimination while on dialysis.

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Received: 23 September 2009 Revision requested: 26 October 2009 Accepted: 17

November 2009

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1432-2277.2009.01025