Saudi Journal of Kidney Diseases and Transplantation

BRIEF COMMUNICATION
Year
: 1999  |  Volume : 10  |  Issue : 2  |  Page : 157--160

Viral Hepatitis in Renal Transplant Patients


Bassam Bernieh, Abdulrahman Osman Mohamed, Irshad Ahmad Sirwal, Adel Wafa, Mohd. Adnan Abbade, Ahmad Tabbakh 
 Nephrology Department, King Fahad Hospital, Madina Al Munawarah, Saudi Arabia

Correspondence Address:
Bassam Bernieh
Dept. of Nephrology, King Fahad Hospital, Madina Al Munawarah
Saudi Arabia

Abstract

Hepatitis is emerging as a common serious problem in renal transplant patients. To determine the prevalence of viral hepatic in our transplant population, we screened the patients who received renal transplants in the period from 1979-1997, inclusive, for hepatitis B virus (HBV) and for hepatitis C virus (HCV) infection. Of those patients screened for HBV infection, seven o f101 recipients (6.9%) were found positive for HbsAg. During the follow up, one patient cleared HbsAg and one from the negative group acquired it. Of the recipients screened for HCV antibodies 32 of 78 patients (41%) had positive tests. Higher incidence of chronic liver disease (37.5%) was found in the HCV positive group, compared to zero in the negative group. However, no difference in the short-term graft loss (25%), was noted between these two groups. We conclude that prevalence of hepatitis C in our transplant patients is high and may have an impact on their long-term outcome.



How to cite this article:
Bernieh B, Mohamed AO, Sirwal IA, Wafa A, Abbade M, Tabbakh A. Viral Hepatitis in Renal Transplant Patients.Saudi J Kidney Dis Transpl 1999;10:157-160


How to cite this URL:
Bernieh B, Mohamed AO, Sirwal IA, Wafa A, Abbade M, Tabbakh A. Viral Hepatitis in Renal Transplant Patients. Saudi J Kidney Dis Transpl [serial online] 1999 [cited 2020 Oct 25 ];10:157-160
Available from: https://www.sjkdt.org/text.asp?1999/10/2/157/37222


Full Text

 Introduction



The recipients of renal transplants are at increase risk of acquiring hepatitis B virus (HBV) and hepatitis C virus (HCV) infection from the dialysis procedures, blood transfusion or through the donated organ.[1],[2] The impact of renal transplantation and consequent immunosuppressive treatment on the liver disease is variable, ranging from minimal changes to chronic persistent hepatitis, chronic active hepatitis, and cirrhosis. [3],[9] Furthermore, there is progressive worsening of liver damage in transplanted individuals with HBV or HCV infection with possible poor outcome. [4],[8],[9] In our center, we have previously reported a 60% prevalence of positive anti-HCV in patients on regular hemodialysis. [2] In this study, we attempt to determine the prevalence of viral hepatitis B and C and liver disease in anti­HCV and HbsAg positive patients and their impact on patient and graft survival after renal transplant.

 Materials and Methods



This is a retrospective study of patients who had renal transplantation during the 18-year period 1979 through 1997, and who were followed up after renal transplantation at King Fahad Hospital, Madina. One hundred and one renal transplant recipients wee screened for infection with HBV and 78 patients were screened for HCV infection. All patients were receiving prednisolone, Azathioproine, and Cyclosporin for immuno­suppression.

Enzyme-linked immunosorbent assay (ELISA) was used for detection of antigen of HBV (HbsAg) and ELISA II for anti­bodies of HCV confirmed by recombinant immuno-blot assay (RIBA) II. Elevation of transaminases (alanine aminotransferase and aspartate transaminase) > twice the normal level on two or more occasions was considered abnormal Liver biopsies were performed and read in the pathology laboratory in our hospital.

 Statistical Analysis



Comparison of the means was performed using the Student "t" test. The significance level was set to P [7],[10],[11] The clinical outcome of chronic hepatitis was found to be better among HbsAg-negative than in HbsAg positive individuals. [12] This study showed that 6.9% of our transplanted patients were positive for HbsAg. This figure is much higher than that in the western reports, [13],[14] but is similar to the prevalence of 6.4% reported previously from this country. [6] The fact that four patients (40%) with positive HbsAg had abnormal liver functions and one died of liver failure suggests that renal transplant­ation may be associated with poor outcome in this group of patients. Recently, it has been recommended that liver biopsy should be done to any patient with HbsAg before transplantation and those with chronic active hepatitis and those with evidence of viral replication (HBeAg and HBV DNA) should be excluded form the transplantation program. [15]

The prevalence of HCV antibodies in renal transplant patients ranged from 10-54%. [3],[4],[5],[6] Some 30-54% of patients with anti-HCV antibodies can be expected to maintain normal liver function throughout their post transplant follow-up. However, as liver function could be normal in patients with chronic active hepatitis, live biopsy is the only way to give definitive information regarding chronic liver damage. [3],[4],[5] In our study, 30.4% of patients screened for HCV antibodies before transplantation were positive. This figure is about half the value we previous reported in our study on HCV serology in our dialysis population. [2] This suggests that transplantation may not be associated with increased incidence of HCV infection and that most of HCV positivity is acquired before transplantation.

The impact of pre-transplant HCV infection on the clinical outcome after transplantation is controversial. Many studies show that pre-transplant HCV infection associated with increased risk of adverse outcome after renal transplantation. [14],[15],[16] In sharp contrast, other studies have shown that the presence of HCV antibodies at the time of renal transplantation does not affect the graft or patients survival after transplantation. [17],[18],[19],[20] In our study, the graft survival was almost identical in the HCV positive and negative groups, and there was no significant difference in creatinine level in those who remained with functioning grafts. Only one patients of HCV positive group died of liver disease. Similar results were reported by many groups, suggesting that the graft or patients survival is probably not affected by the presence of HCV antibodies at the time of renal transplantation. [21] However, other workers in Saudi Arabia observed signi­ficant graft loss among the HCV positive group (27% vs. 1.8%). [6]

The differences in the findings of the various workers could be a reflection of the level of HCV antibodies in the different dialysis groups, the methods used in the studies and/or the differences in the populations studied.

We conclude that transplantation does not seem to be associated with increased incidence of HCV infection, most of HCV positivity being acquired before transplant­ation. However, renal transplantation is associated with an increased prevalence of liver disease in patients who are HCV positive before transplantation.

 Acknowledgement



The authors would like to express great appreciation to Dr. Mohd. Allam for his statistical help and Mrs. Elena Canabe for preparing this manuscript.

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