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Dr Ahmad Talal Asif, Dr Sheikh Muhammad Rehman Zia, Zahid Hussain


Background: The effect of cirrhosis on post-transplantation kidney graft survival is not well established. Previous studies demonstrate a reduced rate of survival (31%) in comparison with the overall rate of survival in five years (31%) among cirrhotic patients who underwent transplantation of kidney. Data is scarcely available on the topic of graft survival among patients experiencing kidney transplantation alone with concomitant cirrhosis. Objective: The objective of this research was to analyze the experience about the cirrhotic patients presenting End-Stage Renal Disease experiencing KTA along with the determination of graft survival. Patients & Methods: We carried out this research at Mayo Hospital, Lahore from April 2018 to February 2019 on a total of 131 patients who received transplantation of kidney. These patients also presented HBV, HCV or cryptogenic cirrhosis; whereas, 12 patients presented concomitant cirrhosis in the course of transplantation. We also compared the three years of survival rate with the national average rate. Patients were included in the research after informed consent. We also secured ethical review board permission before the commencement of research. Patients were also briefed about the research protocols. KTA patients were divided into cirrhotic and non-cirrhotic groups. The cirrhotic group included aged-matched patients who presented CLD history with cirrhosis evidence through biopsy. The non-cirrhotic group also consisted of age-matched groups who presented chronic liver disease without any evidence of cirrhosis or fibrosis through radiographic or histopathological approach among those who experienced KTA in the same timeframe. We also assessed the demographics, parameters of kidney disease and parameters of hepatic disease of the patients. Patient survival, 3-years rate of graft survival and 5-years rate of graft survival were posted KTA associated outcomes. Results: Among twelve patients there were 2 patients who presented cirrhosis etiologies HBV, 7 patients of HCV and 3 patients with cryptogenic. These patients were histologically confirmed before transplantation of the kidney at six months or within six months. Mean graft survival was reported as 8.1 years, graft survival at three years was 75% and at five years was 58%. Conclusion: Initial information proposes that the patients of cirrhosis may be considered for kidney transplantation and liver transplantation. The graft survival rate at three years was much below the average value of the national survey (82%). This research also exhibits the advantages of liver biopsy in the presence or absence of measurement of portal pressure before the act of transplantation with hepatic diseases and hepatitis to an accurate stage of fibrosis. Keywords: Transplantation, Liver, Kidney, HCV, HBV, Kidney Graft and Cirrhosis.


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