AZATHIOPRINE HEPATITIS IN KIDNEY-TRANSPLANT RECIPIENTS - A PREDISPOSING ROLE OF CHRONIC VIRAL-HEPATITIS

Influence of viral liver diseases on the occurrence of azathioprine he patitis was evaluated in 21 kidney transplant recipients. Diagnosis of azathioprine hepatitis was always based on jaundice, which disappeare d after azathioprine withdrawal in 18 patients and after azathioprine dose reduction in 3 patients, Histopathological diagnosis of azathiopr ine toxicity was ascertained in 14 patients. Rechallenge with azathiop rine performed in 4 patients, within 2-4 months after the first jaundi ce episode, resulted in relapse of jaundice in all eases, Viral hepati tis B virus and hepatitis C markers were present in all 20 tested pati ents (serum hepatitis B surface antigen in 6 patients and anti-HCV ant ibodies ill 17 patients). Biopsy-proven chronic hepatitis was observed in 18 patients, including 14 chronic active hepatitis, 3 chronic pers istent hepatitis and cirrhosis in 1, In kidney transplant recipients, azathioprine hepatitis seems to be facilitated or induced by hepatitis B virus or hepatitis C virus chronic hepatitis, Azathioprine reductio n or withdrawal should therefore be combined with the diagnostic evalu ation and the treatment of viral liver diseases.