A study of Liver disease in Renal Transplant Recipients.

BACKGROUND : Infections and liver disease are still major problems in renal transplant recipients. Bacterial, fungal, and viral infections are presumably related to impaired host resistance from immunosuppressive therapy. Liver disease is reported in up to 60% of transplant recipients and carries a high mortality. Several types of liver disease can occur. The most common are acute and chronic hepatitis. The variety of acute hepatitis includes hepatitis A, hepatitis B, hepatitis C, cytomegalovirus hepatitis, herpes simplex hepatitis and drug induced hepatitis. Chronic hepatitis is a serious problem because the disease seems to be progressive despite prednisone therapy. Chronic liver disease (CLD) is a frequent complication after renal transplantation, representing the fourth cause of death in most series. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are the most important causes of CLD in renal transplant patients. Both HBV and HCV infections have a deleterious effect on long-term graft and patient survival in the long run. Also, liver disease is the leading cause of death in these infected patients. AIMS : 1. To analyze the clinical profile, etiology and outcome of renal transplant recipients presenting with clinical and/or biochemical evidence of hepatic dysfunction. 2. To assess the impact of HBV and HCV infection on patient and graft survival in a group of kidney transplanted patients. 3. To compare the survival rate of infected patients with noninfected patients. MATERIALS AND METHODS : This study is a prospective study conducted in the department of nephrology during the time period from august 2007 to December 2009. Renal transplant recipients with clinical or biochemical evidence of acute hepatic dysfunction were included in the study. A detailed diagnostic workup done was performed to establish the etiology of hepatic dysfunction. Patients were analyzed for pretransplant liver status (which included Liver Function Tests, viral serology, vaccination status, risk factors for liver disease). All the diagnostic work up done for liver dysfunction in the post transplant period were noted for detailed analysis (which included LFT, ultrasonogram of Abdomen, viral serology, UGI scopy,Renal biopsy, liver biopsy etc.). Outcome was assessed in terms of resolution of liver dysfunction, allograft function and mortality at defined time periods (at the time of presentation, 3 and 6 months after presentation). CONCLUSIONS : Viral infections were found to be the commonest cause of hepatic dysfunction followed by immunosuppressive medications. Pre transplant blood transfusion contributed significantly to post transplant hepatotropic viral infection. Occurrence of post renal transplant hepatic dysfunction was earlier in patients with Pre transplant hepatitis virus infection. Hepatitis C was the most common viral infection observed. Cholestatic jaundice was the predominant clinical presentation. Hepatitis B and C virus infections did not have any impact on patient and graft survival. Commonest cause of mortality observed was sepsis