IMPLICATIONS OF CHRONIC HEPATITIS-B OR HEPATITIS-C INFECTION FOR RENAL-TRANSPLANT CANDIDATES

Citation
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
Citations number
45
Categorie Soggetti
Urology & Nephrology",Transplantation
ISSN journal
09310509
Volume
10
Year of publication
1995
Supplement
6
Pages
88 - 92
Database
ISI
SICI code
0931-0509(1995)10:<88:IOCHOH>2.0.ZU;2-Y
Abstract
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.