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. |
