title: Kidney transplantation alone in end-stage renal disease patients with hepatitis B liver cirrhosis: a single-center experience.
abstract: BACKGROUND
  Kidney transplantation (KT) alone in end-stage renal disease (ESRD) patients with hepatitis B virus liver cirrhosis (LC) is controversial. This study compared outcomes of KT in hepatitis B surface antigen-positive patients with ESRD with (LC group) and without LC (non-LC group).
  
  
  METHODS
  Outcomes were analyzed in 103 hepatitis B surface antigen-positive patients with ESRD who underwent KT alone between 1997 and 2011. Ninety-one were in the non-LC group and 12 were in the LC group. Of the latter, eight were Child-Pugh (CP) class A and four were CP class B.
  
  
  RESULTS
  Baseline aspartate transaminase and alanine transaminase levels were higher in the LC group. model for end-stage liver disease (MELD) scores were similar in patients with CP class A and class B, only serum albumin level was lower in CP class B. After KT, one CP class A patient showed an increase in the CP score from 5 to 10 points, MELD score from 22.3 to 44.1 points. The CP and MELD scores of the other 11 patients in the LC group did not increase. All four pre-KT CP class B patients were reclassified as class A after KT because of elevated serum albumin levels. Four patients in the LC group developed hepatocellular carcinoma at a median of 35 months (range, 20-57 months) after KT. The 5-year patient survival rate was similar in the LC and non-LC groups (100% vs. 94%, P=0.15). The incidence of pre-KT LC did not differ between survivors and nonsurvivors (11% vs. 18%, P=0.61). Occurrence of hepatocellular carcinoma was significantly higher in nonsurvivors than in survivors.
  
  
  CONCLUSIONS
  Kidney transplantation alone may be safe in patients with compensated hepatitis B virus LC.
authors.affiliation: 1 Division of Nephrology, Department of Internal Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea. 2 Department of General Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.
authors.forename: Kyeong Woo
authors.initials: KW
authors.lastname: Nho
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Duck Jong
authors.initials: DJ
authors.lastname: Han
authors.forename: Su-Kil
authors.initials: SK
authors.lastname: Park
authors.forename: Soon Bae
authors.initials: SB
authors.lastname: Kim
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000821:virology; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality / Q000821:virology*; D008113:Liver Neoplasms / Q000821:virology; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D006514:Hepatitis B Surface Antigens; D012709:Serum Albumin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000075462:Serum Albumin, Human