LONG-TERM OUTCOME OF RENAL-TRANSPLANTATION IN HEPATITIS-B SURFACE ANTIGEN-POSITIVE PATIENTS IN CYCLOSPORINE ERA

The impact of hepatitis B virus (HBV) infection on the outcome of rena l transplantation (Tx) has been controversial. To determine the indica tion of renal Tx in patients infected by HBV, we investigated the long -term outcome of renal transplant patients with hepatitis B surface an tigen (HBsAg). We analyzed 980 patients, including 18 HBsAg carriers, who underwent renal Tx and were immunosuppressed with cyclosporin in o ur institute. Fourteen out of 18 patients (77.8%) showed hepatic dysfu nction after an average period of 17.8 months (range 1-65) after Tx. F our out of 14 patients (28.5%) with hepatic dysfunction died of liver failure due to fulminant hepatitis with functioning grafts between 15 and 71 months after Tx. The remaining 10 patients with hepatic dysfunc tion are alive up to the time of last follow-up; however, 5 of them lo st their grafts because of rejection between 44 and 92 months after Tx . Their liver function improved after withdrawal of cyclosporin. Only 4 patients did not develop chronic liver disease and have had function ing grafts for between 44 and 147 months. One patient died of subarach noid hemorrhage 22 months after Tx. HBe antigen, antibody and HCV anti body status were not related to the occurrence of liver dysfunction af ter Tx, Four HBV-DNA-positive patients showed deteriorated liver funct ion. Three patients with chronic active hepatitis confirmed by the bio psy were treated with interferon. Interferon improved liver function i n 2 patients, however, 1 patient died of liver failure despite interfe ron therapy. Our data suggested that the presence of HBsAg is often as sociated with chronic liver disease leading to liver failure regardles s of HBe and HCV status after Tx. The indication of renal Tx in patien ts with HBsAg should be determined carefully giving consideration to t hese results.