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Chronic hepatitis in kidney allograft recipients
Insights
Renal transplantation is suitable for kidney patients with chronic liver disease, regardless of Hepatitis B surface antigen (HBsAg) status. Outcomes for HBsAg-positive and negative recipients were comparable, indicating HBV status doesn't preclude transplantation.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Medicine
Background:
- Chronic liver disease is a concern in kidney transplant candidates.
- Hepatitis B virus (HBV) infection, indicated by Hepatitis B surface antigen (HBsAg), can affect liver health.
- The impact of renal transplantation on chronic liver disease and vice versa needs evaluation.
Purpose of the Study:
- To assess the effects of renal transplantation on chronic liver disease in HBsAg-positive and HBsAg-negative kidney recipients.
- To compare patient and allograft survival rates between HBsAg-positive and HBsAg-negative groups.
- To investigate the role of chronic alcohol consumption in liver disease among kidney transplant recipients.
Main Methods:
- Comparison of 98 HBsAg-positive and 31 HBsAg-negative kidney recipients.
- Diagnosis of chronic liver disease through liver biopsy analysis.
- Semiquantitative evaluation of histological features of chronic hepatitis.
- Examination of serial liver biopsy specimens.
- Actuarial analysis of patient and allograft survival.
Main Results:
- Chronic liver disease developed in 88% of HBsAg-positive and 4% of HBsAg-negative recipients with normal baseline liver function.
- Liver abnormalities included chronic persistent hepatitis (32%), chronic active hepatitis (51%), and cirrhosis (17%) in HBsAg-positive patients.
- Patient survival rates were 78% (HBsAg-positive) and 87% (HBsAg-negative).
- Allograft survival rates were 64% (HBsAg-positive) and 71% (HBsAg-negative).
- Chronic alcohol consumption was more prevalent in patients with chronic liver disease, irrespective of HBV status.
Conclusions:
- Renal transplantation appears appropriate for hemodialysis patients with chronic hepatitis, irrespective of their Hepatitis B virus (HBV) status.
- Hepatitis B surface antigen (HBsAg) status did not significantly impact patient or allograft survival post-transplantation.
- Chronic liver disease management and alcohol consumption should be considered in kidney transplant recipients.
Abstract:
98 HBsAg-positive and 31 HBsAg-negative kidney recipients were compared to assess the effect of renal transplantation on chronic liver disease and vice versa. Diagnosis was based on analysis of liver biopsy specimens including semiquantitative evaluation of histological features of chronic hepatitis. Serial specimens were examined: chronic liver disease occurred in 88% of HBsAg-positive patients and 4% of HBsAg-negative patients with normal liver at the time of transplantation. Liver abnormalities in the former were chronic persistent hepatitis (32%), chronic active hepatitis (51%), and cirrhosis (17%). Actuarial patient survival was similar in HBsAg-positive (78%) and HBsAg-negative (87%) patients, as was allograft survival (64% and 71%, respectively). In both HBsAg-positive and HBsAg-negative patients chronic alcohol consumption was more frequent in those with chronic liver disease than those without. These data suggest that renal transplantation may be appropriate for haemodialysis patients with chronic hepatitis whatever their HBV status.