Abstract: TH-PO1140
Liver Biopsy Does Not Change Transplant Candidacy Decisions for Hepatitis B Virus-Positive Living-Donor Kidney Transplant Recipients
Session Information
- Transplantation: Clinical - Pretransplant Management
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Yoon, Jung a, Asan Medical Center, Seoul, Korea (the Republic of)
- Park, Keun-hoi, Asan Medical Center, Seoul, Korea (the Republic of)
- Kim, Hyosang, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
- Kim, Soon Bae, Asan Medical Center, Seoul, Korea (the Republic of)
- Park, Su-Kil, Asan Medical Center, Seoul, Korea (the Republic of)
- Baek, Chung Hee, Asan Medical Center, Seoul, Korea (the Republic of)
Background
Hepatitis B virus (HBV) infection in kidney transplantation (KT) recipients is associated with increased overall mortality, graft loss, and progression of liver disease after KT. Liver biopsy is the gold standard for hepatic diagnosis, but it is an invasive and painful procedure. This study evaluated the necessity of liver biopsy in the decision concerning transplant candidacy among HBV-positive living-donor KT recipients.
Methods
This single-center retrospective study reviewed 3,532 patients who underwent KT from February 1997 to March 2015. Outcomes were analyzed for 144 hepatitis B surface antigen (HBsAg)-positive patients with end-stage renal disease who underwent liver biopsy. To compare clinical characteristics, we divided the patients into two groups according to the degree of fibrosis based on METAVIR score. Pathologic findings without fibrosis (F0) were found in 65 (49.6%) cases, and 79 (50.4%) patients were included in the fibrosis group (fibrosis score F1 to F4).
Results
There was no significant difference in age, sex, mode of dialysis before KT, proportion of deceased-donor KT, aspartic acid transaminase levels, total bilirubin, albumin levels, and prothrombin time between non-fibrosis patients and fibrosis patients The Child–Pugh scores were similar between patients with or without fibrosis (p=0.155). There was no liver failure after KT in non-fibrosis patinets, and five (6.3%) fibrosis patients progressed to liver failure (p=0.064). Hepatocellular carcinoma was diagnosed in 2 (3.1%) non-fibrosis patients and 6 (7.6%) fibrosis patients (p=0.294). Biopsy-confirmed acute rejection occurred in 12 (18.5%) non-fibrosis patients and 22 (27.8%) fibrosis patients (p=0.187). The 5-year graft survival rate was 96.9% in non-fibrosis patients and 94.6 % in fibrosis patients. There were no significant differences in graft and patient survival between patients with or without fibrosis (p=0.381 and p=0.113, respectively).
Conclusion
The graft and patient survival were not affected by fibrosis detected by pre-KT liver biopsy. Additionally, fibrosis status did not significantly affect liver-related outcomes among HBsAg-positive recipients. In the new antinucleos(t)ide era, liver biopsy findings might not be helpful for guiding the management of HBsAg-positive KT candidates.