摘要:

Ninety patients on dialysis, 241 cadaveric kidney donors and 27 cadaveric kidney recipients with a follow-up of 2 years, have been investigated as for anti-HCV positivity by means of 3 tests. As for patients on dialysis and cadaveric donors, the prevalence was 32 and 4%, respectively. As for transplanted patients, it must be noted that 4 negative recipients from positive donors seroconverted, but without any change in hepatic enzymes, while in 2 or 9 anti-HCV-positive recipients, hepatic enzymes increased after transplantation. Seroconversion in patients transplanted from a negative donor was not significantly different. We conclude that, according to their experience, anti-HCV positivity in the donors is not associated with a significant risk of infection in recipients of cadaveric grafts.

ISSN:1660-8151    

DOI:10.1159/000186904

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Because of the great problem of viral hepatitis in hemodialysis patients, the Italian Society of Nephrology decided to perform a national epidemiologic survey. We contacted 467 nephrological centers by a questionnaire which let us have information on 25,746 uremic patients: 18,338 on HD, 2,250 on PD and 5,176 with kidney transplant, respectively 78.5% of the total Italian dialysed patients and 91.4% of the total transplanted patients. Statistical analyses were performed. HBV infections occur in 7.8% of the patients (2,008 cases) but considering that 485 cases became spontaneously negative, the true overall incidence of chronic carriers falls to 4.9%. The main causes of the infection are reported as transfusions (64.3%) and dialysis environment (12%). The vaccination program performed by 93.2% of the centers, obtained an efficacious seroconversion in 4,626 of 7,790 cases vaccinated: the vaccine currently most utilized is the recombinant type administered by means of 3 versus 4 boosters. In the 2nd part of the survey, we report information concerning the presence of nephropaties associated with HBV infections in nonuremic patients (208 cases). We present and discuss the clinical picture of the nephropaties, the hystologic bioptic pattern and the prognosis of the kidney pathology.

ISSN:1660-8151    

DOI:10.1159/000186905

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A review is presented on the results achieved in HBV immunization of hemodialysis patients with aluminum-adsorbed, subunit plasma-derived and yeast-derived vaccines. The main host-related and immunization-related causes of low response are discussed. Various possibility to improve the vaccine performance through appropriate dosage and schedule, as well as immunopotentiating procedures are reported.

ISSN:1660-8151    

DOI:10.1159/000186906

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The contamination of dialysis machines is an important risk factor for the spread of viral hepatitis in hemodialysis units. The use of reserved machines in separate rooms is a safe prophylactic measure.

ISSN:1660-8151    

DOI:10.1159/000186907

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

278 azathioprine and methylprednisolone (AZA)-treated and 406 ciclosporin (CS) treated patients with a kidney graft functioning for more than 1 year were investigated for the presence of chronic liver disease (CLD), defined as an increase in transaminases of 1.5 times the upper normal limits for a period of at least 12 months. The prevalence of CLD was 36 and 27% in the two groups, respectively. The univariate analysis showed that male sex, alcohol abuse and HBsAg positivity correlated with CLD onset in the AZA group while blood transfusions, length of dialysis treatment, pretransplantation CLD, HBsAg positivity and ferritin levels over 800 ng/ml correlated with CLD onset in CS. The multivariate analysis identified male sex and HBsAg positivity in the AZA group and age over 18 years, high ferritin levels and HBsAg positivity in the CS group as risk factors predictive of CLD onset. Liver failure represented the 4th cause of death in the AZA group but 1 of the 2 most important causes of death in CS in the long term. However, these drawbacks were overcome by the overall low mortality rate in CS. Therefore, renal transplantation should not be refused to patients positive for HBsAg and/or with preexisting liver disease.

ISSN:1660-8151    

DOI:10.1159/000186908

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A controlled trial of hepatitis B vaccination with recombinant antigen was undertaken in 18 hemodialysed end-stage renal failure (ESRD) patients (P) and 16 members of our staff (controls, C). In order to identify expected nonresponders (NR), we monitored T lymphocyte (Tc) subsets, peripheral blood mononuclear cells (PBMC), total leukocytes (WBC) and IgG. After 3 vaccine doses of 40 and 20 IU, respectively, for P and C, at 0,1 and 6 months, 11 P (61.1%) and all C (100%) responded, as in previous reports [1-3]. The 7 NR presented lower CD4 + Tc fraction, compared to responders (R) and C (p < 0.05), and higher monocyte (p < 0.00001) and WBC (p < 0.002) counts, with lower lymphocyte fraction (p < 0.001), compared to R. We suggest that NR could represent a selected group of ESRD patients, screenable by these easily detectable features, probably markers of a specific immune dysfunction.

ISSN:1660-8151    

DOI:10.1159/000186909

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

In 12 hemodialysis (HD) patients with persistently raised serum alanine aminotransferase concentrations, 6 of which with anti-HCV antibodies, a liver biopsy was performed. The histological examination showed chronic persistent hepatitis or less significant changes in 11 patients and mild chronic active hepatitis in only 1. Non-A, non-B hepatitis seems to demonstrate in HD patients a low tendency to induce an active and progressive liver disease.

ISSN:1660-8151    

DOI:10.1159/000186910

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A search for antibodies against hepatitis C virus (HCV) was performed in 185 patients on chronic hemodialysis by means of 1st and 2nd generation ELISA tests. Immunoblot assays were performed on positive sera. This study shows a 38% prevalence of HCV-positive patients in our dialysis population according to the 2nd generation ELISA test which shows a higher specificity and sensitivity when compared to the 1st generation one (38 vs. 20%). A correlation was found between the prevalence of HCV-positive patients and how long they had been on dialysis and how many blood transfusions they had received.

ISSN:1660-8151    

DOI:10.1159/000186911

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We evaluated the prevalence of hepatitis in our hemodialysed population (65 patients, 37 M and 28 F). Screening for A and B hepatitis was tested with the RIA method and research of the anti-HCV with the immunoenzymatic method (Ortho HCV ELISA test of 2nd generation). 15 patients (23.07%) were anti-HCV positive (anti-HCV + ); 23 (35.38%) showed positivity for 1 or more markers of B hepatitis (HBV +). A meaningful greater prevalence of B virus infections in anti-HCV + patients (86.66%), compared to negatives, (20.00%) resulted. All non-A, non-B hepatitides are anti-HCV +. The dialytic treatment of the anti-HCV + patients was meaningfully longer than in the negatives (p < 0.05). The prevalence of the seropositive patients to B and C virus is not correlated to the number of transfusions, while it is to the number of surgical operations carried out in the predialytic period. This information suggests common pathogenetic mechanisms between the 2 forms of hepatitis and increased probability to find anti-HCV + with a longer dialytic treatment.

ISSN:1660-8151    

DOI:10.1159/000186912

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

It was the purpose of this study to evaluate the spread of HCV infection among the staff at Dialysis Units and among relatives of anti-HCV-positive hemodialysis patients. 122 health-care workers and 52 relatives were screened for presence of anti-HCV Ab. The control groups consisted of 100 health-care workers from other wards and 30 relatives of anti-HCV-negative subjects. 2.45% of the healthcare staff and 5.8% of the relatives were found to be anti-HCV Ab carriers. None of the subjects in the control groups were positive. In conclusion, the results of this study indicate that there is a real possibility of HCV spread through occupational exposure although the corresponding percentage in less than that presumably due to within-the-family contagion by the virus.

ISSN:1660-8151    

DOI:10.1159/000186913

出版商:S. Karger AG    

年代:1992

数据来源: Karger