E. Goffin et al., IMPLICATIONS OF CHRONIC HEPATITIS-B OR HEPATITIS-C INFECTION FOR RENAL-TRANSPLANT CANDIDATES, Nephrology, dialysis, transplantation, 10, 1995, pp. 88-92
Hepatic cirrhosis and clinically active hepatitis due to HBV or HCV in
fection clearly contraindicate kidney transplantation. More controvers
ial is the attitude to be adopted towards candidates with clinically q
uiescent chronic HBV or HCV infection. The presence of the HBs antigen
does not adversely affect survival or increase morbidity on maintenan
ce haemodialysis, at least during the first decade. After transplantat
ion, by contrast, the long-term outcome of HBV infection is undoubtedl
y worse than on haemodialysis: more patients develop chronic hepatitis
and eventually die from liver disease. The risk of fatal liver diseas
e after transplantation is greater in patients with markers of active
viral replication before transplant and in those with severe histologi
cal liver lesions, Pretransplant candidates should be warned of this s
ignificant risk factor. Comparison of survival of HCV-infected patient
s on haemodialysis and after transplantation is not yet possible. The
outcome of HCV infection after transplantation appears less severe tha
n that of HBV infection: the survival of anti-HCV-positive patients is
similar to that of anti-HCV-negative patients, at least during the fi
rst decade after transplantation. Liver biochemical abnormalities, ser
ological markers and detection of HCV RNA are of little value to ident
ify patients at greater risk of poor outcome after transplantation. On
ly liver biopsy might help identify such patients. Both efficacy and r
isks of antiviral therapies are yet to be properly assessed during hae
modialysis. Preliminary evidence suggests that interferon therapy give
n after transplantation entails an unacceptable rate of deterioration
in graft function. At the present time, positive HBs antigen with nega
tive HBe antigen as well as anti-HCV-positive patients with clinically
quiescent infection should not be denied kidney transplantation.