Liver disease is an important cause of morbidity and mortality in patients of end stage renal disease treated by dialysis. Abnormal Liver Function Tests (LFTs), mostly caused by hepatotropic viruses – HBV & HCV are encountered in 10–44% of such patients. Prevalence of HBV & HCV in this population is variable (3.4–45% of HBV & 4.3- 45.2% of HCV). Post-transplantation, liver diseases cause late morbidity and occur in 38% of long term survivals. Apart from HBV & HCV, CMV becomes an important issue and is reported in 20-60% of all transtplant recipients. Disease manifestations of CMV include hepatitis, pneumonitis, colitis, bone marrow suppression and pyrexial debilitating illness. In India, only few studies have been done on the incidence of liver dysfunction and hepatotropic viral infectons (HBV, HCV & CMV) in chronic kidney disease patients undergoing transplantation. Also, it is not clear whether immuno-supression after transplantation leads to increased rate of sero-positivity and hence increased prevalence of deranged LFTs. This is an ongoing prospective study of 100 patients of end stage renal disease, taken up for renal transplantation at PGIMER, Chandigarh. Patients are evaluated for derranged LFTs and viral markers (HBsAg, Anti-HCV, HCV RNA (Qualitative), IgM CMV serology, pp65 & PCR for CMV DNA If required). Patients of chronic liver diseases due to non-viral etiologies were excluded. Liver dysfunction is defined as ALT > 1.5 times the upper limit of normal (i.e. 40 IU/ml) and/or total bilirubin > 2 mg%) Pre-transplant, derranged LFTs were found in !2 patients (12/70;17%). Of them, one each had HBV and HCV infection. Of the 58 patients with normal LFTs, two each were positive for HBV and HCV respectively whereas one had dual HBV and HCV positivity. At 3 months post-transplant, all 12 patients continued to have derranged LFTs with same HBV or HCV status. In addition one developed fever with deranged LFTs, pancytopenia and was positive for CMV DNA on PCR, with negative IgM serology & pp65 antigenemia. All 4 HCV positive cases were detected by HCV RNA. 17% of pre-transplant patients had derranged LFTs. HBV & HCV has been incrimated in 8.3% (1/12) of these patients which remained same at 3 months post-transplant. CMV was found in 7.6% (1/13) of renal transplant reciepients with derranged LFTs.
