Clinical Course of Chronic Viral Hepatitis B and C in Renal Transplant Recipients

Choi, Bum Soon; Kim, Hyung Wook; Park, Joo Hyun; Yang, Chul Woo; Kim, Yong Soo; Kim, Suk Young; Choi, Euy Jin; Chang, Yoon Sik; Moon, In Sung; Koh, Yong Bok; Bang, Byung Kee

Abstract

PURPOSE: The aim of this study was to evaluate the clinical course of chronic viral hepatits in renal transplant recipients.
METHODS
During the period from January 1980 to December 1998, a total of 1122 cases of kidney transplantation (KT) were performed at the Kangnam St. Mary's Hospital. Eighty- one transplant recipients received azathioprine (AZA) and 1041 transplant recipients received cyclosporin A (CsA). We tested hepatitis B surface antigen (HBS Ag) and hepatitis C virus antibody (HCV Ab). According to duration of hepatic dysfunction, radiologic examination and liver biopsy, clinical course of hepatitis was classified; (1) Health carrier: HBs Ag or HCV Ab positive with normal laboratory finding. (2) Chronic hepatitis: clinical and/or laboratory evidence of hepatic dysfunction that persisted more than 6 months. (3) Liver cirrhosis and hepatocellular carcinoma (HCC); liver ultrasonography, abdominal CT and liver biopsy.
RESULTS
(1) The patients with HBs Ag positive were 117 cases (10.4%). Sixteen cases died within 1 year after KT because of hepatic failure or other complication. We followed up 101 cases. Sixty-seven cases (66.4%) were health carrier and two of them progressed to HCC. Thirty-four cases (33.5%) developed chronic hepatitis B and liver cirrhosis was developed in 10 cases (29.4%). (2) Because of availability of diagnostic method, 877 cases were tested for HCV Ab. The patients with HCV Ab positive were 94 cases (10.7%). Four cases died within 1 year after KT. Thirteen cases (13.8%) were both HBs Ag and HCV Ab positive. We followed up 75 cases only HCV Ab positive. Fifty-three cases (70.7%) were health carrier and 22 cases (29.3%) progressed to chronic hepatitis C. Any case did not progressed to liver cirrhosis or HCC. (3) Eight cases of HCC were developed from chronic hepatitis B, and one case was both HBs Ag and HCV Ab negative. Among these, male gender is predominant (male : female=7 : 2). The average age at KT were 37.9 years. HCC was diagnosed at 102.6 (range 44 to 173) months after KT. Eight cases received CsA and prednisolone and only 1 case received AZA and prednisolone. Two cases underwent surgical intervention and the other 7 cases treated with transarterial chemoembolization and chemotherapy. The average survival was 10.4 (1 to 40) months, 3 cases are still alive.
CONCLUSION
Clinical course of HCV infection is less aggressive than that of HBV infection in renal transplant recipients.