The effect of hepatitis B antigenemia on long-term success and hepatic disease in renal transplant recipients.

The records of 192 cadaver renal allotransplants were reviewed in order to evaluate the role of the hepatitis B antigen (HBsAg) carrier state on graft function, patient survival, and the incidence of severe hepatic dysfunction. Twenty-one allografts were placed into patients with hepatitis B antigenemia. After follow-up ranging from 1.5 to 8 years (mean 4.7), graft and patient survivals were not statistically different from antigen-negative patients. In addition, the acquisition of HBsAg after grafting did not seem to affect the rate of graft failuue or death. Neither cirrhosis not fatal hepatic failure developed in the HBsAg carrier group, whereas five HBsAg-negative recipients died of hepatic disease. Among HBsAg-positive recipients, nine with functioning renal allografts and five with graft failures, there was a low incidence of e antigen, suggesting low infectivity. This may explain the lack of correlation of the surface antigen with serious liver disease. Severe hepatic disease developing in renal graft recipients is most likely attributable to causes other than hepatitis B infection. The presence of hepatitis B antigenemia alone should not be a deterrent to renal transplantation.