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 LEN 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/di 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 fulrninant hepatitis or chronic liver disease. In summary, our presented data suggest that treatment of HCV uremic patients by LEN 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 HBV 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 LEN 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 immunosuppression herapy suitable o these patients as well as close monitoring of graft function after kidney transplantation. |
