The Effect of Pretransplant Liver Functions on the Short-Term Outcome of Renal Transplantation in Patients with Chronic Renal Failure
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Hepatic cirrhosis and clinically active hepatitis due to HBV and HCV infections, clearly contraindicate kidney transplantation. More controversial is adopted towards candidates with clinically quiescent chronic HBV or HCV. In an attempt to study the impact of pretransplant liver dysfunctions and etiology of liver diseases on the shortterm outcome of renal transplantation, we prospectively followed up 75 end stage renal diseased patients on regular hemodialysis and were arranged for living donor kidney transplantation for 18 months after renal transplantation. We found that HCV patients treated by IFN as well as pure schistosomal renal allograft recipients had excellent graft function during the follow up period. Moreover, number of rejection episodes was non-significantly lower than the control group. Also, we found that HCV (not treated by IFN) showed non-significant elevation of serum creatinine especially during the first 8 months after kidney transplantation. However, after that, serum creatinine dropped and was non-significantly different from the control group. The mixed HCV and HBV infection group showed significant pre-transplant impaired liver function in comparison to control group but after kidney transplantation, serum creatinine was non-significantly higher than control group. Also, number of rejection episodes was non-significantly higher than control group. Unfortunately, mixed HCV and schistosomiasis group had had results; 50% experienced more than 3 rejection episodes during their follow up period. Their mean serum creatinine 2.5 mg/c11 versus 1.24 mg/c11 in control group. Moreover, number of rejection episodes was nearly double that of control group (2.38 versus 1.24). None of our patients developed fulininant hepatitis or chronic liver disease. In stunmary, ouppresented data suggest that treatment of HCV uremic patients by IFN may contribute to better post-transplant graft function. Neither HCV nor schistosomiasis alone affect the short term out come either of the patients or graft survival after kidney transplantation. Mixed HCV and REV may cause more susceptibility to rejection episodes. Also, patients with mixed HCV and schistosomiasis carry high risk to patients as well as graft survival after kidney transplantation. We recommended IFN therapy for HCV RNA positive haemodialysis patients and further studies to detect the possible pathogenesis of impaired graft survival in mixed HCV and schistosomiasis patients and postulation of new regimen of inununosuppression therapy suitable to these patients as well as close monitoring of graft function after kidney transplantation.