Cadaveric Renal Transplantation between Donor and Recipient Both are Hepatitis B Virus Positive / 대한신장학회잡지

ABSTRACT

There has been studies constantly reporting on high rate mortality of renal transplantation of hepatitis B virus(HBV)-positive subject because the direct and indirect effect of immunosuppressive agent which was administrated after a transplantation worsens hepatitis or causes hepatic failure. But recent studies have reported that there is no difference in graft rejection, infection and survival rate of the graft or the host between hepatitis positive and negative groups. And, after lamivudine which suppresses HBV replication is introduced into renal transplantation, transplantation of HBV-positive subjects has taken on a new aspect. But it has been hard to find the reports about renal transplantation between donor and recipient both are hepatitis B virus positive in documents, because, in most cases of those reports, the recipient was hepatitis B virus positive but the donor who offers kidney was hepatitis virus negative. This study selected all 9 cases of cadaveric renal transplantation between HBV-positive cadaveric donor and HBV-positive chronic renal failure(CRF) patient who were operated at Samsung medical center from March of 1997 to August of 2000, then analyzed the medical records of five donors and nine recipients retrospectively. Six cadaveric donors(5 male, 1 female, age 15-52) and nine recipients(4 male, 5 female, age 23-52, median dialysis period 23 months) were included. During following up periods of 42 to 12 months (median 24 months) after renal transplantation with HBV DNA, serum ALT and serum creatinine change of hepatic function and renal function were observed and a development of infection and other complication were also investigated. Any case didn't come out fulminant hepatitis or liver cirrhosis. Four cases came out hepatic dysfunction. Among these, one case was diagnosed to CsA hepatotoxicity. One case came out a transient increase of ALT more than six months, since then was normilized. One case came out acute hepatitis and one case recurrent hepatitis. The rest constantly came out normal hepaitc function. In all the cases lamivudine treatment was practiced and the major indication were positive HBV DNA and a increase of ALT. In the recent test the eight cases came out a normal ALT and the only one case came out a little increase of ALT, 60 IU/L. Renal function was relatively well maintained. Three cases came out acute rejection, but it was successfully recovered. Chronic rejection didn't occur. In the recent test the eight cases came out a normal serum creatinine except one case(28 month after transplantation) which 1.5 mg/dL of serum creatinine appeared. When we consider our situation possessing much more recipients than donors of renal transplantation, this trial to expand the scope of donor to HBV- positive patients as well as the activation of cadaveric renal transplantation is a clinically meaningful effort especially in Korea and Asian countries which have a plenty of hepatitis carriers and chronic hepatitis patients. And we consider this new trial needs to continue comparative analyzation through long term observation.