Kidney Transplantation Alone in End-Stage Renal Disease Patients with Hepatitis B Liver Cirrhosis

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Abstract

Background

Kidney transplantation (KT) alone in end-stage renal disease (ESRD) patients with hepatitis B virus-induced liver cirrhosis (LC) remains controversial. This study compared outcomes of KT in hepatitis B surface antigen (HBsAg)-positive patients with ESRD with LC (LC group) and without LC (non-LC group).

Methods

Outcomes were analyzed in 116 HBsAg-positive patients with ESRD who underwent KT alone between 1997 and 2013 and who were followed for at least 1 year. Ninety-nine were in the non-LC group and 17 were in the LC group; of the latter, 12 were Child Pugh (CP) class A and five were CP class B.

Results

Baseline aspartate transaminase (AST) and alanine transaminase (ALT) levels were higher in the LC group. Model for end-stage liver disease (MELD) scores were similar in patients that were CP class A and B; only serum albumin level was lower in CP class B. After KT, one CP class A patient showed increases in CP score (from 5 to 10 points) and in MELD score (from 22.3 to 44.1 points). The CP and MELD scores of the other 16 patients in the LC group did not increase. All five pre-KT CP class B patients were reclassified as class A after KT because of elevated serum albumin levels. Four patients in the LC group developed hepatocellular carcinoma a median of 35 months (range, 20–57 months) after KT. The 5-year patient survival rate was similar in the LC and non-LC groups. The occurrence of hepatocellular carcinoma was significantly higher in patients who died than in survivors.

Conclusions

KT alone may be safe in patients with compensated hepatitis B virus-induced LC.

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