RESUMO
OBJECTIVE: To investigate the outcome of the kidney transplant recipients with different grades and stages of chronic hepatitis B virus after receiving renal transplantation for 3 years. METHODS: Thirty nine cases of kidney transplant recipients with hepatitis B virus and 20 cases of kidney transplant recipients (control group) between August 2000 and February 2002 were studied. Before the transplantation, the patients were divided into 4 groups: the mild hepatitis group (Group A, n = 8), the middle hepatitis group (Group B, n = 6), the severe hepatitis group (Group C, n =5) according to pathological diagnosis by percutaneous liver biopsy, and the control group (Group D). During the 3 year follow-up, the serum creatinine, alanine aminotransferase, g-Glutamyl transferase (GGT), total bilirubin, direct bilirubin, prothrombin time, cyclosporine trough concentration, urinary protein excretion, the HBV markers, HBV-DNA, albumin (A), globulin (G), the hepatic fibrosis markers and Child-Pugh score were studied at intervals. All patients received ultrasound examination every year. Two patients received repeated liver biopsy at the end of the follow-up in the hepatitis groups. RESULTS: The outcome of Group A and Group D was fine. In Group B, GGT level was significantly elevated (P < 0.05) sixth months after the operation, the Child-Pugh score of 2 patients were B, the liver pathohistological changes in another 2 patients were in severe stage in the endpoint. In Group C, GGT values had higher base-line (P <0.01) during the follow-up. Albumin were lower and globulin were higher than normal at the beginning of the 24th month. At the end of the follow-up, the Child-Pugh scores of all patients were B or C (B = 3, C = 2), 4 patients had end-stage cirrhosis, one died of hepatic cancer and the survival rate was 40% in Group C. CONCLUSION: The outcome of the 3 groups is different. The pathohistological diagnosis by liver biopsy is important for patient selection receiving renal transplantation.
