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Implications of chronic hepatitis B or hepatitis C infection for renal transplant candidates
E Goffin1, Y Pirson, C van Ypersele de Strihou
1Department of Nephrology, Cliniques Universitaires St Luc, Bruxelles, Belgium.
Insights
Kidney transplant candidates with quiescent hepatitis B virus (HBV) or hepatitis C virus (HCV) infection face risks. HBV infection worsens post-transplant outcomes, while HCV outcomes appear less severe, though liver biopsy may predict risk.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Immunology
Background:
- Active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection contraindicates kidney transplantation.
- The management of kidney transplant candidates with quiescent chronic HBV or HCV infection remains controversial.
- HBs antigen presence does not negatively impact survival or morbidity during the first decade of maintenance hemodialysis.
Purpose of the Study:
- To evaluate the outcomes of kidney transplantation in patients with quiescent HBV or HCV infection.
- To compare the risks and benefits of transplantation versus continued hemodialysis for these patient groups.
- To identify predictors of poor outcomes after kidney transplantation in HBV/HCV-infected individuals.
Main Methods:
- Review of patient survival and morbidity data for hemodialysis and post-kidney transplantation.
- Analysis of liver disease progression, including chronic hepatitis and liver failure.
- Assessment of viral replication markers, liver histology, and biochemical/serological tests for risk stratification.
Main Results:
- Long-term outcomes for HBV infection are worse after transplantation than on hemodialysis, with increased risk of fatal liver disease, especially with active viral replication or severe histology.
- HCV infection outcomes post-transplantation appear less severe than HBV, with similar survival rates to uninfected patients in the first decade.
- Liver biochemical abnormalities, serological markers, and HCV RNA detection have limited value in predicting post-transplant risk; liver biopsy may be more informative.
Conclusions:
- Kidney transplant candidates with quiescent HBV infection face a significant risk of worse long-term outcomes and liver disease progression post-transplantation.
- HCV infection outcomes post-transplantation seem more favorable than HBV, but careful patient selection and monitoring are crucial.
- Further research is needed to assess antiviral therapies in hemodialysis patients and evaluate their efficacy and risks, particularly post-transplantation, given preliminary data on interferon's negative impact on graft function.
Abstract:
Hepatic cirrhosis and clinically active hepatitis due to HBV or HCV infection clearly contra-indicate kidney transplantation. More controversial is the attitude to be adopted towards candidates with clinically quiescent chronic HBV or HCV infection. The presence of the HBs antigen does not adversely affect survival or increase morbidity on maintenance haemodialysis, at least during the first decade. After transplantation, by contrast, the long-term outcome of HBV infection is undoubtedly worse than on haemodialysis: more patients develop chronic hepatitis and eventually die from liver disease. The risk of fatal liver disease after transplantation is greater in patients with markers of active viral replication before transplant and in those with severe histological liver lesions. Pretransplant candidates should be warned of this significant risk factor. Comparison of survival of HCV-infected patients on haemodialysis and after transplantation is not yet possible. The outcome of HCV infection after transplantation appears less severe than that of HBV infection: the survival of anti-HCV-positive patients is similar to that of anti-HCV-negative patients, at least during the first decade after transplantation. Liver biochemical abnormalities, serological markers and detection of HCV RNA are of little value to identify patients at greater risk of poor outcome after transplantation. Only liver biopsy might help identify such patients. Both efficacy and risks of antiviral therapies are yet to be properly assessed during haemodialysis. Preliminary evidence suggests that interferon therapy given after transplantation entails an unacceptable rate of deterioration in graft function.(ABSTRACT TRUNCATED AT 250 WORDS)