Abstract
Data regarding the risk of various liver diseases among different hepatitis viruses in kidney transplantation have not yet been identified.We selected individuals with kidney transplantation (ICD-9-CM V420 or 996.81) from 2000–2009 from the catastrophic illness registry of National Health Insurance Research Database (NHIRD)as the study cohort. The two end-points in the study included overall death, and post-transplant occurrence of hepatic disease. After adjustment for other risk factors, the risk of mortality was increased in patients with HBV infection (N = 352) and with HCV infection (N = 275) compared to those with neither HBV nor HCV infection (N = 3485). In addition,renal transplant recipients with HBV alone,HCV alone, and both with HBV and HCVinfectionrespectively had an approximately 10-fold hazard ratio (HR) = 9.84, 95% confidence interval (CI): 4.61–21.0, 4-fold increased risk (HR = 4.40, 95% CI: 1.85–10.5)and 5-fold increased risk (HR = 4.63, 95% CI: 1.06–20.2)of hepatocellular carcinoma (HCC)compared to those with neither HBV nor HCV infection. Our findings showed a significant risk of de novo liver disease in recipients with hepatitis virus infection. Based on our findings, we reinforce the importance and impact of hepatitis virus in renal transplantation.
Highlights
Post-transplantation liver disease is suggested to be associated with adverse outcomes in kidney transplantation which was considered as the fourth most important cause of mortality in kidney recipients[1,6,7]
The 4,133 kidney recipients were divided into three groups: 3485 patients with neither hepatitis B virus (HBV) nor hepatitis C virus (HCV) infection (Group 1), 336 (8.13%) with HBV infection (Group 2), 262 (6.34%) with HCV infection (Group 3) and 50 (1.21%)
After adjustment for age, sex, DM, hypertension, CGN, heart failure and CAD, the risk of virus hepatitis in patient survival showed an adjusted hazard ratios (HRs) = 2.99, 95% confidence intervals (CIs): 2.13 to 4.18 in transplant recipients with HBV infection, an adjusted HR = 2.05, 95% CI: 1.52 to 2.76 in those with HCV infection and an adjusted HR = 1.36, 95% CI: 0.61 to 3.07 in those both withHBVand HCV infection (Table 2)
Summary
Post-transplantation liver disease is suggested to be associated with adverse outcomes in kidney transplantation which was considered as the fourth most important cause of mortality in kidney recipients[1,6,7]. Hepatitis virus infection is thought to play an important role in post-transplant liver disease Both HBV and HCV infection have been suggested as being associated with progressive liver diseases after transplantation, including liver cirrhosis, hepatocellular carcinoma (HCC) and hepatic failure. A remarkably high prevalence of chronic hepatitis virus infection is found in kidney transplant patients, with HBV infection reaching approximately 20.9% and HCV, 46.3%, respectively[4]. With these findings, we are striving to determine the long-term outcomes of kidney transplant patients with hepatitis virus infection and further clarify the relationship between the hepatitis virus, immunosuppression and risk of individual subtype liver disease after transplantation in a nationwide cohort study
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