Impact of hepatitis B and C virus infection on the outcome of kidney transplantation in Chinese patients.
BACKGROUND
There has been improvement in kidney transplantation over the years; however, the impact of hepatitis B and C virus (HBV, HCV) infection on the long-term outcome of kidney transplant is still controversial.


METHODS
A total of 113 patients who received renal allografts from 1986 to 1998 were analyzed. Nine were positive for both hepatitis B surface antigen (HBsAg) and antibody to HCV (anti-HCV) (Group 1), 20 were HBsAg-positive and anti-HCV-negative (Group 2), 30 were HBsAg-negative and anti-HCV-positive (Group 3) and 54 were negative for both markers (Group 4). The outcome and survival were compared among the four groups of patients.


RESULTS
The mean follow-up period was 5.1 +/- 3.2 years (range, 0.5-13 years) for all patients. Group 2 patients had significantly higher liver-related complications (35% vs 0%, p < 0.0001) and liver-related deaths (20% vs 0%, p = 0.004) than did Group 4 patients. Among all, four HBsAg-positive patients had fulminant hepatitis and died within two years of transplantation. Three (Group 2) of the patients who died were seropositive for hepatitis B e antigen and/or HBV DNA and none had a history of or positive serologic marker to indicate hepatitis of other etiologies. The remaining patient (Group 1) had evidence of superinfection of HCV. Liver cirrhosis occurred in one, two and one patient in Groups 1, 2 and 3, respectively, and hepatocellular carcinoma occurred in two and one patient in Groups 2 and 3, respectively. Despite high liver-related mortality in HBV-infected patients, paradoxically, no significant differences among the four groups in the long-term graft and patient survivals were demonstrated. The presence of HBsAg or anti-HCV was not associated with a poor prognosis of survival as determined by Cox regression analysis.


CONCLUSIONS
HBV or HCV infection is not a contraindication to kidney transplantation in Chinese patients. However, it should be noted that serious liver-related complications may occur and limit survival in HBV- and/or HCV-infected patients after kidney transplantation.
Huo
T I
TI
Department of Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
Yang
W C
WC
Wu
J C
JC
King
K L
KL
Loong
C C
CC
Lin
C Y
CY
Lui
W Y
WY
Chang
F Y
FY
Lee
S D
SD
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications*; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged
D006514:Hepatitis B Surface Antigens