The impact of hepatitis B infection on the clinical outcome of renal transplantation has been controversial. Some investigators reported excess mortality from hepatic failure and/or concurrent sepsis while others found no such detrimental effect. Since the clinical or biochemical data do not reflect the severity or the course of liver disease in these immunosuppressed patients, we performed percutaneous liver biopsies and systematically analyzed the histological findings in 68 patients who had clinical evidence of chronic liver disease in the posttransplant period. Twenty-six of these patients were HBs Ag-positive and 42 were HBs Ag-negative. There were no significant differences in the demographic data, biochemical variables, or the mean follow-up between the two groups.
Results: HBs Ag-positive patients had more severe histological forms of liver disease, i.e., chronic persistent hepatitis (CPH) (38%) and chronic active hepatitis (CAH) (38%), compared with 17% CPH and 14% CAH in HBs Ag-negative patients (CPH, P = 0.08; CAH, P = 0.04). The incidence of cirrhosis was also higher in the HBs Ag-positive patients (42% vs. 19%, P = 0.07). During a mean follow-up of 82 +/- 58 months from the onset of hepatitis, 54% of hepatitis B-positive patients died from liver failure compared with 12% of the B-negative group, who were followed for a mean period of 74 +/- 47 months from the onset of hepatitis. The difference in mortality rate was highly significant (P = 0.002). Comparison of initial histology with a follow-up specimen in 25 patients (13 HBs Ag-positive, 12 HBs Ag-negative) also showed a trend towards higher frequency of liver cirrhosis in the B-positive patients compared with the B-negative group (P = NS). Our observations, based on liver histology, confirm earlier reports that hepatitis B infection is associated with a bad prognosis in renal allograft recipients, who have clinical evidence of chronic liver disease.