1979 Volume 70 Issue 2 Pages 135-143
Hepatic dysfunction in renal allograft recipients has been recognized as one of the important complications with high incidence. There have been only a few reports about the relationship between hepatic dysfunction and graft function or chronic rejection. In order to delineate this relation, retrospective study of 66 adult renal allografts (including 4 cadaveric) functioning for 4 to 72 months was performed. A significantly lower incidence of chronic rejection was noticed in the group with hepatic dysfunction versus the group without hepatic dysfunction.
The results are summarized as follows.
1. We experienced two cases who had stopped receiving azathioprine and cyclophosphamide for more than two and a half years because of persistent elevation of s-GPT and/or s-GOT. No episodes of acute or chronic rejections were observed during these periods and they had good graft function. This fact and the report by Shriff indicate that the renal allograft recipients who had the complication of hepatic dysfunction or bone marrow suppression due to azathioprine and cyclophosphamide, could be controlled by discontinuing the administration of these drugs.
2. Forty of 66 recipients (61%) developed evidence of hepatic dysfunction. This was defined as elevation of s-GPT more than 50 IU for over 2 weeks.
3. Hepatic dysfunction occurred within 5 months after transplantation in all of the cases; twenty-eight of 66 (70%) of the cases occurred within 1 month.
4. There were 7 cases with hepatic dysfunction where azathioprine and cyclophosphamide were stopped because of persistent elevation of s-GPT (over 200 IU): 3 patients died from liver failure, 2 patients improved, and 2 cases (presented) had no significant changes of liver function.
5. Fourteen of 40 patients (35%) with hepatic dysfunction had acute rejection episodes versus 14 of 26 patients (54%) without hepatic dysfunction. This reveals no significant correlation between hepatic dysfunction and acute rejection.
6. In 26 recipients who were free from hepatic dysfunction there were 11 patients (42%) having chronic rejection, while in 40 recipients who had hepatic dysfunction there were only 7 cases (18%) with chronic rejection. A statistically significant correlation between hepatic dysfunction and chronic rejection was observed (p<0.05). No significant differences were observed in graft survival between the group with and without hepatic dysfunction. —There was no significant difference between the 2 groups in either histocompatibility as determined by mixed lymphocyte culture or follow-up period.
7. Thus, we conclude that Hepatic dysfunction may be beneficial to graft function, however the cause is obscure.
