We evaluated the impact of concomitant infection with Hepatitis B virus (HBY) and Hepatitis C virus (HCY) on the clinical course after renal transplantation (Tx). In 335 patients (pts) transplanted between 1991 and 1993 we found 30 (9%) recipients who were positive for Hepatitis B surface antigen (HBsAg) (ELISA, Organon) and anti-HCY antibodies (immunoblot assay Lia Tek) preTx. Chronic liver disease (CLD) (two-fold or greater increase in serum ALT and AST levels for at least six months) developed in 40.7% coinfected pts as compared to 24.4% and 25.7% pts infected only with HCY or HBY, respectively. Maintenance immunosuppression consisted ofP+Aza+CsA, mean follow-uptime was 28:!: 15 months. The mean time of the onset ofCLD was 3.0 months (range: 1-18 months) after Tx. Percutaneous liver biopsy performed in 5 CLD pts revealed chronic active hepatitis (CAH) in 4 and chronic persistent hepatitis (CPH) in I pt. Four pts who had CAH and were positive for HCY RNA (RT PCR) in serum and for HBcAg in liver tissue, received interferon-alpha therapy for 6 months. Clinical improvement of liver function was observed in all of them, but none cleared HBsAg or HCY RNA. One pt lost his graft due to acute rejection. Concomitant infection with HBY and HCY is associated with the high risk of development of CLD early after Tx. We recommend that pretransplant evaluation of both anti-HCV and HBsAg positive pts should include liver biopsy to exclude potential recipients with CAH.

Keywords: Kidney Transplantation, Hepatitis Bvirus, hepatitis C virus, chronic liverdisease (CLD)