Renal transplant in hepatitis B and C positive patients--a ten years experience

To determine the outcome of renal transplantation in hepatitis B (HBsAg) and C (HCV antibody) positive end-stage renal disease (ESRD) patients.

In past ten years, out of 245 live renal transplants performed 33 (13.63%) (mean age 36.5 +/- 10.7 yr.) recipients tested positive for HBsAg and/or HCV Ab. Eighteen were HCV Ab positive, 10 HBsAg positive and five both. Two HBsAg positive cases transplanted elsewhere and followed up at our centre were also included. Pre-transplant, thirteen patients had elevated serum alanine aminotransferase (serum ALT). Of these 13, 10 patients were subjected to liver biopsy. Seven showed changes of chronic hepatitis (CH) while three were normal. Seven patients with CH on liver biopsy and three who refused biopsy but had elevated serum ALT were treated with interferon (IFN). In all ten cases there was normalization of serum ALT and six patients (2 HCV and 4 HBV) even became sero-negative.

The actuarial 1, 5 and 10 year patient survival was 94.28%, 85.71% and 85.71% and the graft survival was 88.5%, 77.1% and 77.1%, respectively. Infection was the commonest causes of death and rejection was the commonest cause of graft loss. Post-transplant, one patient, (HCV antibody positive) died of fulminant hepatic failure and eleven patients developed elevated serum ALT levels which normalized in six recipients after lamivudine therapy and in four cases on their own.

Our study shows that the patient and graft survival in hepatitis seropositive recipients is similar to non-hepatitis recipients. Most patients maintain stable liver function over a follow up period of six months to ten years. Lamivudine therapy is effective and safe in post-transplant period.