HEPATIC ALTERATIONS IN KIDNEY TRANSPLANT RECIPIENTS FROM THE LARGEST KIDNEY TRANSPLANT CENTER IN BRAZIL

VIEIRA, Gustavo de Almeida; AMARAL, Ana Cristina de Castro; CARVALHO FILHO, Roberto José de; SOUZA, Ana Lucia da Silva; MEDINA-PESTANA, José Osmar; FERRAZ, Maria Lucia Gomes

doi:10.1590/S0004-2803.202200001-12

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ORIGINAL ARTICLE • Arq. Gastroenterol. 59 (01) • Jan-Mar 2022 • https://doi.org/10.1590/S0004-2803.202200001-12 copy

HEPATIC ALTERATIONS IN KIDNEY TRANSPLANT RECIPIENTS FROM THE LARGEST KIDNEY TRANSPLANT CENTER IN BRAZIL

Alterações hepáticas em transplantados renais do maior centro de transplante do Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

Kidney transplant is the treatment of choice for patients with end-stage renal disease and is associated with lower mortality when compared to dialysis methods. Brazil is the country with the second largest number of kidney transplants in the world and among these patients it has been observed that liver abnormalities are common. The frequency of liver abnormalities ranges from 20-50% post-transplantation, and have an important impact on the survival and quality of life of these patients. There are scarce data about the frequency, causes and characteristics of these alterations.

Objective

To determine the prevalence of the different causes of hepatic abnormalities in kidney transplant recipients, to associate the characteristics of these abnormalities with demographic, epidemiological and clinical variables, to compare the characteristics of hepatic alterations between different etiologies, and to evaluate possible changes in diagnosis over two different periods of time.

Methods

Descriptive, cross-sectional observational, epidemiological study was conducted at the outpatient “Hepato-Rim”clinic of Hospital São Paulo (EPM/UNIFESP), a center providing specialized care for patients with hepatic abnormalities and underlying kidney diseases.

Results

Five-hundred eighty-one transplant patients were evaluated. The most prevalent etiologies of liver abnormalities were hepatitis C and B, iron overload, nonalcoholic fatty liver disease (NAFLD), and drug-induced liver injury (DILI). The most common cause — hepatitis C — was analyzed in greater detail. Compared to the other causes, this infection was more frequent in older patients, female patients, and patients with a longer time since transplantation and hemodialysis. Analysis of the two periods showed that patients of period 1 (P1 — 1993 to 2005) were older and were more frequently referred because of positive serology; referral due to aminotransferases abnormalities predominated during period 2 (P2 — 2006 to 2018). The predominant diagnoses were hepatitis C and B during P1 and NAFLD and DILI during P2.

Conclusion

Assessment of the main hepatic alterations in kidney transplant recipients is important because it permits better management of these patients in terms of diagnostic investigation and treatment and contributes to the prevention of complications in this special population.

Keywords:
Kidney transplant; hepatic alterations; liver disease

Variable
Age in years (mean ± SD)	57.0±10.8
Male gender	66%
Origin
Southeast	48.5%
Northeast	26.2%
Others	25.3%
Etiology of kidney disease
Indeterminate	41.7%
Arterial hypertension	29.8%
Nephritis	12.9%
Diabetes mellitus	4.3%
Polycystic disease	3.4%
Systemic lupus erythematosus	1.2%
Recurrent urinary tract infection	1.5%
Donor type
Deceased	52.8%
Living	40.4%
Time since transplantation in years (mean ± SD)	9.7±7.05
Duration of hemodialysis in years (mean ± SD)	5.3±4.43

Final diagnosis	Number of patients with the diagnosis
Hepatitis C	310
Hepatitis B	133
Iron overload	107
Nonalcoholic fatty liver disease	54
Drug-induced liver injury	50
Alcohol	35
Schistosomiasis	14
Cholestasis	8
Hepatocellular carcinoma	3
Polycystic disease	3
False-positive HCV	2
Primary biliary cholangitis	1
Primary sclerosing cholangitis	1
Amyloidosis	1
Cured hepatitis B	1
Liver hemangioma	1
Benign cholestasis of pregnancy	1
Total	725

Parameter	HCV +	HCV -	P
	(n=310)	(n=415)
Age in years	57.8±10.4	55.9±11.1	0.04
Male gender	61.9%	70.5%	0.03
Etiology of CKD
DM2	4.5%	4.1%	0.84
SAH	13.5%	12.7%	0.71
Nephritis	27.4%	32.5%	0.20
Time since transplantation in years	10.7±7.4	8.6±6.4	<0.001
Duration of hemodialysis in years	5.7±4.3	4.8±4.4	0.005
APRI	0.8±0.9	0.9±1	0.005
ALT	1.3±1.4	1.8±2.5	0.15
AP	1.6±2.2	1.4±1.2	0.62
GGT	4.2±8.9	5.2±8.4	0.17

Variable	P1	P2	P
Variable	(n= 299)	(n=255)	P
Age in years (mean ± SD)	58.4±10.8	55.2±10.7	<0.001
Male gender	62.4%	68.6%	0.18
Origin
Southeast	41.5%	57.6%	<0.001
Northeast	24.1%	27.8%	<0.001
Others	34.4%	14.5%	<0.001
Etiology of kidney disease
Diabetes mellitus	3.3%	5.5%	0.24
Arterial hypertension	28.8%	30.6%	0.64
Nephritis	12.4%	13.3%	0.8
Donor type
Deceased	52.8%	51%	0.59
Living	41.1%	40.8%	0.59
Time since transplantation in years (mean ± SD)	10.3±6.9	8.8±7.1	0.05

Diagnostic	P1 (n=299)	P2 (n=255)	P
HCV	64.9%	40.9%	<0.001
HBV	68.5%	49.5%	<0.001
Iron overload	55%	49%	0.31
NASH	37.3%	55.7%	<0.005
DILI	33.3%	55.8%	0.005

Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. Rua Dr. Seng, 320, 01331-020 São Paulo - SP Brasil, Tel./Fax: +55 11 3147-6227 - São Paulo - SP - Brazil
E-mail: secretariaarqgastr@hospitaligesp.com.br

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[1] Corresponding author: Gustavo de Almeida Vieira. E-mail: almeida.ura@gmail.com