الفهرس 
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Abstract
Patients with ESRD are treated by many modalities , one of them is renal transplantation , which intends increasing patient survival , decreasing morbidity and mortality due to renal failure complications and providing patient with better quality of life , but renal transplantation has some problems that needs nephrologists’ efforts to overcome , one of them is hepatic dysfunction .
Our study aimed to the evaluation of the possible etiology, prognosis, Management and significance of hepatic dysfunction in renal transplant recipients.
Our study reviewed 500 renal transplant recipient files as a retrospective study at National institute of nephrology & urology, and Nasser institute.
Among them 388 patients had hepatic dysfunction at any period of time during the study follow up duration(48 months), and 112 patients had normal liver function allover the study period.
On comparing both groups the following were concluded
1-Viral infection is a main cause of hepatic dysfunction, as (64.4%) of patients suffering of hepatic dysfunction had a viral infection.
2-HCV is an important cause of hepatic dysfunction (204/246 patients (82.9%)) of HCV +ve patients have hepatic dysfunction).
3-Duration of dialysis (pre transplantation were 20.42 ± 16.54 in hepatic patients), and the blood transfusion (36.6% of hepatic patients) are an important risk factor for HCV and therefore hepatic dysfunction in renal transplant recipient.
4-Rural area residents are at more risk for developing hepatic dysfunction ((42.2%) of hepatic patient).
5-HBV is a confirmed cause of hepatic dysfunction (100% of HBV have hepatic dysfunction).
6-Combined infection with HCV and HBV is a certain cause of hepatic dysfunction (100% of combined HCV and HBV infection patients have hepatic dysfunction).
7-CMV is not confirmed to be a certain leading cause of hepatic dysfunction post transplantation.
8-Schistosomiasis of the recipients is an important cause of hepatic dysfunction (89 of 100 schistosomiasis +ve history patients (89%) have hepatic dysfunction).
9-Post transplant new onset diabetes mellitus was associated with hepatic dysfunction (43 of 50 NODAT patients (86%) have hepatic dysfunction) .
10-Cyclosporine A is associated with hepatic dysfunction which is mostly dose dependent.
11-Tacrolimus is associated with hepatic dysfunction which is mostly dose dependent.
12-Mycophenolate mofetil MMF is associated with hepatic dysfunction in high dose.
13-Sirolimus is associated with hepatic dysfunction.
14-Azathioprine is associated with hepatic dysfunction which is dose dependent and reversible.
15-Corticosteroids may be associated with hepatic dysfunction both in high dose and in long term intake even in low doses.
16- Immunosuppression regimens that mostly associated with hepatic dysfunction were
a- Cyclosporine A, Azathioprine, steroid.
B- Cyclosporine A , MMF , steroid .
C- Tacrolimus, MMF, steroid.
17- Induction therapy is not confirmed to be associated with hepatic dysfunction.
18- Medical complications (hypertension, new onset diabetes post transplant, malignancy) generally higher in hepatic group but not to statistically significant level.
19- Infection with T.B or other infections are comparable between the two groups so hepatic dysfunction is not a risk factor for T.B or other infections post transplantation.
20- HCV is a risk factor for T.B (10 patients (4%) for only 2 (0.8%) in HCV –ve patients ).
21- HCV is a risk factor for NODAT (34(13.8%) in HCV +ve patients , for 16 (6.3%) in HCV –ve patients).
22- Rejection either acute or chronic is not more prevalent in the hepatic dysfunction.
23- Hepatic dysfunction has no significant impact on graft survival (at least in short term).
24- Hepatic dysfunction has no significant effect on patient survival (at least in short term).
So we conclude that, though hepatic dysfunction is an important problem in renal transplantation, it’s not a contraindication to transplantation, on condition of proper diagnosis and management of the causative agent.