Kidney transplantation alone in end-stage renal disease patients with hepatitis B liver cirrhosis: a single-center experience.

BACKGROUND: Kidney transplantation (KT) alone in end-stage renal disease (ESRD) patients with hepatitis B virus liver cirrhosis (LC) is controversial. This study compared outcomes of KT in hepatitis B surface antigen-positive patients with ESRD with (LC group) and without LC (non-LC group).

METHODS: Outcomes were analyzed in 103 hepatitis B surface antigen-positive patients with ESRD who underwent KT alone between 1997 and 2011. Ninety-one were in the non-LC group and 12 were in the LC group. Of the latter, eight were Child-Pugh (CP) class A and four were CP class B.

RESULTS: Baseline aspartate transaminase and alanine transaminase levels were higher in the LC group. model for end-stage liver disease (MELD) scores were similar in patients with CP class A and class B, only serum albumin level was lower in CP class B. After KT, one CP class A patient showed an increase in the CP score from 5 to 10 points, MELD score from 22.3 to 44.1 points. The CP and MELD scores of the other 11 patients in the LC group did not increase. All four pre-KT CP class B patients were reclassified as class A after KT because of elevated serum albumin levels. Four patients in the LC group developed hepatocellular carcinoma at a median of 35 months (range, 20-57 months) after KT. The 5-year patient survival rate was similar in the LC and non-LC groups (100% vs. 94%, P=0.15). The incidence of pre-KT LC did not differ between survivors and nonsurvivors (11% vs. 18%, P=0.61). Occurrence of hepatocellular carcinoma was significantly higher in nonsurvivors than in survivors.

CONCLUSION: Kidney transplantation alone may be safe in patients with compensated hepatitis B virus LC.