Hepatic dysfunction in kidney transplant recipients: prevalence and impact on graft and patient survival.
BACKGROUND
Liver disease has emerged as an important cause of morbidity and mortality in renal transplant recipients. Liver insufficiency is the cause of death in up to 28% of long-term survivors after renal transplantation. The aim of this work was to evaluate the prevalence and causes of hepatic dysfunction in renal transplant recipients in Egypt, and its impact on both renal graft function and patient survival.


METHODS
This study comprised 447 kidney transplant recipients who received their grafts between January 1999 and December 2003 at Mansoura Urology and Nephrology Center. Among these recipients, 104 patients showed persistent hepatic dysfunction, while the remaining 343 had normal liver function or transient hepatic dysfunction of less than 6 months' duration.


RESULTS
We found that the prevalence of persistent hepatic dysfunction in our recipients was 23.3%. Infections such as hepatitis C virus (HCV;, with longer dialysis duration and blood transfusion as risk factors), HBV, and cytomegalovirus (CMV), were the main causes of persistent hepatic dysfunction. Drugs (e.g., the sirolimus and tacrolimus; cyclosporine; and azathioprine) were also associated with hepatic dysfunction. We did not find a significant impact of hepatic dysfunction on either patient or graft survival.


CONCLUSIONS
Viral infections-especially HCV and CMV-were more prevalent in the group of patients with persistent hepatic dysfunction, with duration of dialysis as an important risk factor for HCV infection. Dose-dependent cyclosporine-induced hepatic dysfunction was observed early post-transplant. Neither tacrolimus- nor sirolimus-associated hepatic dysfunction was dose-dependent. Hepatic dysfunction had no significant impact on either patient or graft survival; however, this finding may be due to the relatively short duration of follow up.
Gheith
Osama A
OA
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. ogheith@yahoo.com.
Saad
Mohamed A
MA
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Hassan
Ahmed A
AA
Department of Internal Medicine, Zagazig University, Zagazig, Egypt.
A-Eldeeb
Salem
S
Department of Internal Medicine, Zagazig University, Zagazig, Egypt.
Agroudy
Amgad E-El
AE
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Sheashaa
Hussein
H
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Ghoneim
Mohamed A
MA
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
D000328:Adult; D003586:Cytomegalovirus Infections / Q000150:complications; D003956:Dialysis / Q000009:adverse effects; D004534:Egypt / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008107:Liver Diseases / Q000209:etiology* / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents