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Kidney transplantation in hepatitis B surface antigen carriers
1Abteilung Nephrologie, Medizinische Hochschule Hannover, Germany.
Insights
Kidney transplants in chronic hepatitis B surface antigen (HBsAg) carriers show good early survival but poor long-term outcomes due to liver disease complications. Early graft survival is better, but late mortality is higher in HBsAg carriers.
Area of Science:
- Nephrology
- Hepatology
- Transplantation
Background:
- Chronic hepatitis B surface antigen (HBsAg) carriers face increased risks of liver disease post-renal transplantation.
- Long-term outcomes for HBsAg carriers undergoing kidney transplantation require further investigation.
Purpose of the Study:
- To assess the long-term impact of liver disease on morbidity and mortality in HBsAg carriers following kidney transplantation.
Main Methods:
- Retrospective analysis of 1977 patients, including 76 HBsAg carriers, who received renal transplants between 1968 and 1992.
- Comparison of patient and graft survival rates, causes of death, and morbidity between HBsAg carriers and HBsAg-negative patients.
Main Results:
- HBsAg carriers demonstrated superior 5-year patient (94% vs 87%) and graft survival (83% vs 61%) compared to HBsAg-negative patients.
- After 10 years, HBsAg carriers experienced significantly higher mortality (34% vs 17%), primarily due to hepatitis B complications (73% of deaths).
- HBsAg-negative patients predominantly died from cardiovascular failure (51%), with liver disease causing only 2% of deaths.
Conclusions:
- Kidney transplantation is justifiable for HBsAg carriers with normal liver function due to low early rejection and mortality.
- Late-onset fatal hepatic deterioration is a significant concern for HBsAg carriers post-transplantation.
- Careful monitoring for liver disease progression is crucial in HBsAg carriers after renal transplantation.
Abstract:
Chronic hepatitis B surface antigen (HBsAg) carriers run a high risk of developing chronic liver disease after renal transplantation. To determine the impact of liver disease on long-term morbidity and mortality of HBsAg carriers following kidney transplantation we analyzed 1977 patients, including 76 HBsAg carriers, who underwent renal transplantation during the period 1968-1992. Although the HBsAg carriers had a better 5-year patient and graft survival rate (94% and 83%) than HBsAg-negative patients (87% and 61%), the prognosis was poor after the tenth year of transplantation. Transplant loss is more frequently caused by death of the HBsAg carriers, in contrast to the total population (34% vs 17% for HBsAg-negative patients). Death occurs in 73% of cases due to complications of hepatitis B. In the HBsAg-negative patients, the predominant cause of death is cardiovascular failure (51% vs 11% in HBsAg carriers), whereas only 2% died of liver disease. Kidney transplantation in HBsAg carriers with normal liver function appears to be justified because of rare graft loss due to acute rejection, low early morbidity and mortality, and late onset of fatal hepatic deterioration.