Hepatitis B liver disease in cyclosporine-treated renal allograft recipients.
To establish the impact of cyclosporine on the development of chronic hepatitis in hepatitis B surface antigen (HBsAg)-positive renal allograft recipients, the incidence and outcome of chronic hepatitis in 20 cyclosporine-treated patients (CsA group) were compared with 13 azathioprine-treated patients (AZA group). All 33 patients had a functioning graft for 2 years or longer. Twenty-nine of the 33 patients were HBsAg-positive prior to the initiation of hemodialysis. The difference in the incidence of chronic hepatitis between these 2 groups was not statistically significant (78.6% in the AZA group vs. 52.4% in the CsA group, P = 0.12). In the CsA group, 3 patients (15%) developed liver cirrhosis, and there was a 5% mortality. The AZA group had a 7.7% mortality, and 4 patients (30.8%) developed liver cirrhosis. Serial serum samples obtained from these 33 HBsAg-positive renal allograft recipients were analyzed for antibody to hepatitis D virus (anti-HD). Anti-HD was found in 3 patients. Two of them developed anti-HD seroconversion after renal transplantation during a mean follow-up of 4 years. All 3 patients developed chronic hepatitis and 2 of them have subsequently developed liver cirrhosis. There was a mortality of 6.1% in 33 HBsAg-positive patients compared with a 5.3% mortality in 57 HBsAg-negative renal allograft recipients. The difference was not statistically significant. We conclude from this study that (1) CsA-treated HBsAg-positive renal allograft recipients have a tendency to develop chronic hepatitis like AZA-treated patients; (2) HBsAg-positive patients have an increased risk of HDV superinfection after renal transplantation, and this may result in rapid progression to liver cirrhosis; (3) HBsAg-positive patients who acquire HBsAg prior to renal transplantation have a low overall mortality, including death due to liver disease, for a mean follow-up of 4 years.
Huang
C C
CC
Department of Medicine and Surgery, Chang Gung Memorial Hospital, Chang Gung Medical School, Taipei, Taiwan, Republic of China.
Lai
M K
MK
Fong
M T
MT
D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D003524:Cyclosporins / Q000627:therapeutic use*; D005260:Female; D006508:Hepatitis Antibodies / Q000032:analysis; D006509:Hepatitis B / Q000150:complications*; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006513:Hepatitis B e Antigens / Q000032:analysis; D003699:Hepatitis D / Q000150:complications*; D003698:Hepatitis Delta Virus / Q000276:immunology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D003524:Cyclosporins; D006508:Hepatitis Antibodies; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D001379:Azathioprine