Hepatitis B infection and renal transplantation: the absence of anti-delta antibodies and the possible beneficial effect of silymarin during acute episodes of hepatic dysfunction.

The incidence of hepatitis B infection among renal transplant recipients was reviewed. Among 90 patients, 13 were HBsAg positive prior to renal transplantation. Episodes of hepatic dysfunction were seen in eight and one died of fulminating hepatitis and disseminated tuberculosis. Silymarin, a herbal extract, appears to confer some benefits in ameliorating hepatic dysfunction. Antibodies to the delta agent were not detected during any of these episodes. One patient contracted hepatitis B after transplantation and rapid reduction in steroid dose was associated with deterioration of liver function. He developed antibodies and cleared the virus. Four HBsAg-negative patients received kidneys from HBsAg positive donors without becoming HBsAg positive.