THE LONG-TERM VIROLOGICAL AND PATHOLOGICAL IMPACT OF RENAL-TRANSPLANTATION ON CHRONIC HEPATITIS-B VIRUS-INFECTION

In an attempt to evaluate the long-term reciprocal impact of renal tra nsplantation on hepatitis B virus infection, we analyzed the clinical, virologic, and pathologic features of 151 HBsAg-positive kidney trans plant recipients. The spontaneous disappearance rates of HBsAg, HBeAg, and HBV DNA during a median follow-up of 125 months (range 1 to 320) were 3, 30.6, and 3%, respectively, figures lower than in the general population. A high rate of persistent viral replication (50%) and reac tivation (30%) was noted, Noteworthy was the high frequency of histolo gic deterioration (85.3%), accompanied by cirrhosis in 28% and by hepa tocellular carcinoma in 23% of the patients with cirrhosis, Go-infecti on by hepatitis C and B viruses was significantly associated with hist ologic worsening, Liver disease was the leading cause of death (36.6%) , especially in patients with cirrhosis. Despite persistent viral repl ication, histopathologic deterioration, and Liver-related overmortalit y, there were paradoxically no significant differences in the survival of these 151 HBsAg-positive compared with 1247 HBsAg-negative kidney recipients-however, allograft actuarial survival was better in the for mer than in the latter group (P=0.0006). Chronic hepatitis B infection is not a contraindication to renal transplantation in the absence of cirrhosis. The presence of cirrhosis should lead either to dialysis co ntinuation or to a combined liver/kidney transplantation, in the absen ce of viral replication.