Renal transplant in hepatitis B and C positive patients--a ten years experience.

OBJECTIVE: To determine the outcome of renal transplantation in hepatitis B (HBsAg) and C (HCV antibody) positive end-stage renal disease (ESRD) patients. MATERIAL AND METHODS: In past ten years, out of 245 live renal transplants performed 33 (13.63%) (mean age 36.5 +/- 10.7 yr.) recipients tested positive for HBsAg and/or HCV Ab. Eighteen were HCV Ab positive, 10 HBsAg positive and five both. Two HBsAg positive cases transplanted elsewhere and followed up at our centre were also included. Pre-transplant, thirteen patients had elevated serum alanine aminotransferase (serum ALT). Of these 13, 10 patients were subjected to liver biopsy. Seven showed changes of chronic hepatitis (CH) while three were normal. Seven patients with CH on liver biopsy and three who refused biopsy but had elevated serum ALT were treated with interferon (IFN). In all ten cases there was normalization of serum ALT and six patients (2 HCV and 4 HBV) even became sero-negative. RESULTS: The actuarial 1, 5 and 10 year patient survival was 94.28%, 85.71% and 85.71% and the graft survival was 88.5%, 77.1% and 77.1%, respectively. Infection was the commonest causes of death and rejection was the commonest cause of graft loss. Post-transplant, one patient, (HCV antibody positive) died of fulminant hepatic failure and eleven patients developed elevated serum ALT levels which normalized in six recipients after lamivudine therapy and in four cases on their own. CONCLUSION: Our study shows that the patient and graft survival in hepatitis seropositive recipients is similar to non-hepatitis recipients. Most patients maintain stable liver function over a follow up period of six months to ten years. Lamivudine therapy is effective and safe in post-transplant period.

Renal involvement in multiple myeloma.

The present study is a retrospective chart analysis of 33 patients who satisfied the diagnostic criteria of multiple myeloma. Sixteen (49.5%) of these 33 patients developed renal failure at some point in time. The mean age +/- 1SD of patients who developed renal failure was 59.2 +/- 13 years (range 34-85 years). There were 12 males and 4 females. The precipitating factors for renal failure were dehydration (12.5%), hypercalcemia (62.5%) and use of non-steroidal antiinflammatory drugs (6.2%). Hypercalcemia was observed in 10 of the 16 patients who developed renal failure while it was seen in only 4 of the 17 cases who did not develop renal failure (relative risk 5.4). In 11 (68.7%) patients, the renal function improved with hydration, treatment of hypercalcemia and chemotherapy. The 1 and 3 year actuarial survival of patients with renal failure and multiple myeloma was 87% and 74% respectively.

Multiple myeloma presenting as proliferative (crescentic) glomerulonephritis.

Glomerular extracapillary cellular proliferation with crescent formation initially presenting as rapidly progressive glomerulonephritis is a rare clinical manifestation of multiple myeloma. We report here a case of a 58 year old female who initially presented with haematuria, loss of weight and appetite and history of febrile episodes and was diagnosed following renal biopsy as rapidly progressive glomerulonephritis. Haemodialysis was carried out a month later because of uremic symptoms and maintained with monitoring of serum, calcium, phosphate, alkaline phosphatase, albumin and iPTH levels. After 6 months, she complained of bone pains over anterior chest wall which persisted even with low calcium haemodialysis. Serum protein electrophoresis and bone marrow aspiration revealed multiple myeloma. On starting chemotherapy, bone pain subsided but the patient expired within 15 days of therapy.

Dyslipidemia in patients with chronic renal failure and in renal transplant patients.

Indian studies on lipid profile abnormalities in chronic renal failure (CRF) have varied from no abnormalities at all to significant abnormality (hypertriglyceridemia and reduced HDL) as described in the Western literature. Moreover, there is no Indian study on the effect of renal transplantation on the abnormal lipid profile of CRF. The aim of our study was to determine the lipid profile of CRF patients on conservative treatment, end stage renal disease (ESRD) patients on maintenance hemodialysis (HD) treatment and renal transplant patients. We also looked at the effect of fish oil rich in polyunsaturated fatty acids (Max-EPA) on hypertriglyceridemia of CRF. The study included 4 groups; Gp I: control subjects (n = 9, age = 30 +/- 5 yrs), Gp II: CRF patients on conservative treatment (n = 9, age = 49 +/- 17 yrs), Gp III: ESRD patients on HD for at least 3 months (n = 19, age = 53 +/- 9 yrs), Gp IV: 3 months post-renal transplant patients (n = 9, age 31 +/- 11 yrs). The lipids and lipoproteins analysed include total cholesterol, HDL, LDL, triglycerides, Apo A1 and Apo B. It was observed that in Gp II patients triglycerides were significantly elevated (p < .05) and Apo A1/Apo B significantly abnormally lower (p < .001) compared to Gp I. In Gp IV patients, there was no significant difference in lipid profile compared to Gp I. With the use of Max-EPA in 5 patients with hypertriglyceridemia, there was a significant improvement in hypertriglyceridemia (p < .05). Our study suggests: 1) significant hypertriglyceridemia does develop in a majority of CRF patients. The abnormality probably improves with dialysis treatment and renal transplantation. 2) A lower Apo A1/Apo B ratio in CRF patients may account for higher risk of atherosclerosis. 3) Fish oil rich in polyunsaturated fatty acids improves hypertriglyceridemia of CRF.