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Renal transplantation in hepatitis B carriers: comparison of azathioprine- and cyclosporine-treated recipients.

Among 137 renal transplant recipients, 53 were treated with an AZA-prednisolone regimen and 84 with a CsA-prednisolone regimen. Carriers of HBV had an increased risk of hepatic dysfunction. Forty-two recipients were HBsAg positive. HBsAg-positive status indicated 60% chronic hepatic dysfunction over 3.58 +/- 1.28 years of follow-up in CsA-treated patients and 64.7% over 6.31 +/- 0.99 years in AZA-treated patients. The presence of HBV markers did not seem to affect the patient and graft survival rates in both the CsA- and AZA-treated patients. However, anti-HBs positive patients had poorer graft survival in AZA-treated cadaveric transplants. Episodes of chronic hepatic dysfunction lead to marked reduction of CsA maintenance dosages. We concluded that it was logical to include HBV carriers in our kidney transplantation program. However, they should be followed closely for the possibility of hepatic dysfunction, liver cirrhosis, and hepatoma.