What Is Involved In A Liver Transplant
A liver transplant is considered necessary when the liver is damaged and cannot function or in some cases of liver cancer. Your liver is very important. It is responsible for many functions related to making sure that your body stays healthy and is able to digest foods.
You may be eligible for a transplant if you have chronic hepatitis B infection or some of the diseases that may result from it, including liver cancer and cirrhosis. You will have to complete testing and be evaluated before being approved for a transplant. It is likely that you will be placed on a waiting list while an appropriate organ is found.
Donated livers come from two types of donors: living and deceased. Because the liver can regenerate, it is possible to use part of a liver for transplant. The remaining sections in both the donor and the receiver will grow into livers of adequate size.
People who get liver transplants must take anti-rejection drugs for the rest of their lives. These drugs make you more susceptible to infection. However, liver transplants have become more successful over time and continue to improve.
Can A Person Get Hepatitis C From Hemodialysis
Hemodialysis, also called dialysis, is the process of allowing a machine to clean the blood. A persons blood travels into the dialysis machine through an IV line, where the machine cleans it by removing waste products from it. It then travels back into their body through the same or another IV line.
It is possible to acquire the HCV infection from hemodialysis, although improved infection control methods have greatly reduced the possibility of this occurring. Because a person comes into contact with needles during the process, there is always the possibility of even a very small amount of cross-contamination occurring.
Additionally, there may be contamination of:
1,000 otherwise healthy kidneys from transplantation because they have come from people who were infected with hepatitis C when they died. Early research indicates that by providing follow-up antiviral therapy, it may be possible to transplant these HCV-positive kidneys into recipients who do not have hepatitis C.
A person can be eligible for a kidney transplant if they have HCV. Their medical team will consider the condition of their liver when making the decision. If the liver is not in good condition and the persons overall health is poor, their doctors may deny them a kidney transplant. If their liver is not in good condition, but their overall health is good, they may be eligible for a dual liver and kidney transplant.
Acute Hepatitis B Symptoms
There are three phases of acute hepatitis B infection, and symptoms may differ depending on the stage. Early in the disease, called the prodromal phase, symptoms may include:
- Dark urine and light stool color
During the icteric phase:
- Jaundice develops
- Anorexia, nausea and vomiting may worsen
- Irritated skin lesions may develop
- Other symptoms may subside
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Hepatitis C And Chronic Kidney Disease
Chronic kidney disease is when there is lasting damage to the kidneys that can get worse in time. Sometimes hepatitis C can cause CKD, but this does not happen very often.
Hepatitis C is connected to CKD because:
- Hepatitis C can cause a type of kidney disease called glomerulonephritis. Your kidneys are made up of thousands of tiny filters called glomeruli. Glomerulonephritis is the inflammation of the kidney filters , which causes permanent damage. When your kidney filters are damaged, this can lead to CKD.
- When you have hepatitis C, you have a higher chance of getting diabetes. Diabetes is the leading cause of kidney disease and kidney failure.
Since there is a connection between hepatitis C and kidney disease, doctors recommended that patients with hepatitis C be tested for kidney disease every year.
- If you have hepatitis C and kidney disease, your health may be worse than kidney patients without hepatitis C.
- Having hepatitis C can lead to a faster progression of CKD into kidney failure compared to people without hepatitis C.
This is why getting tested and treated for hepatitis C is so important for your health.
Hepatitis B In The United States
In the United States, about 862,000 people have chronic hepatitis B.6 Asian Americans and African Americans have higher rates of chronic hepatitis B than other U.S. racial and ethnic groups.10 Researchers estimate that about half of the people living with chronic hepatitis B in the United States are Asian Americans and Pacific Islanders.11 Chronic hepatitis B is also more common among people born in other countries than among those born in the United States.7
The hepatitis B vaccine has been available since the 1980s and, in 1991, doctors began recommending that children in the United States receive the hepatitis B vaccine. The annual rate of acute hepatitis B infections went down 88.5 percent between 1982 and 2015.12 In 2017, the annual number of hepatitis B infections rose in some states.13 Experts think the rise was related to increases in injection drug use. Injection drug use increases the risk of hepatitis B infection.
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Can I Get Hepatitis C Through My Dialysis Treatment
The chance of getting hepatitis C through your treatment is small because of strict standard health precautions used in dialysis units today. However, there have been some reports that hepatitis C has been spread between patients in hemodialysis units where supplies or equipment may have been shared between patients. If you are a long-term hemodialysis patient, you should be tested for hepatitis C when you have your regular blood tests.
Other Infectious Diseases Dialysis Patients Should Know About
MRSA : MRSA is a type of infection that is caused by a type of bacteria called staph. Staph bacteria in a MRSA infection does not respond to many of the antibiotics use to treat staph infections. Most cases of MRSA are found in patients who are in hospitals, nursing homes or being treated with hemodialysis in centers.
To help prevent the spread of MRSA in the unit, your dialysis care team should follow the standard precautions recommended by the National Centers for Disease Control and Prevention and be especially careful to:
- Wear clean and new gloves for performing procedures
- Gloves should be changed between each patient
- Wash their hands after touching a patient or any potentially contaminated articles and before taking care of another patient.
Some MRSA infections have been reported to be treatment failures with vancomycin, one of the drugs most commonly used to treat these infections. These are called VISA, or vancomycin intermediateresistant Staph aureus. A small number of these occurred in dialysis patients with hemodialysis or peritoneal dialysis catheters. In each case, the patient was receiving vancomycin for an extended period of time to treat catheterrelated infections. To help prevent these infections, the same measures used to prevent MRSA should be used.
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Can Hep A Cause Kidney Failure
Hepatitis A, B and C viruses are major causes of viral hepatitis in human. These infectious agents not only damage liver parenchyma but can also affect renal parenchyma. Hepatitis A virus could produce acute renal failure in a similar fashion to hepatorenal syndrome.
Can hepatitis cause protein in urine?
Previous studies have shown that in persons with HCV infection, higher incidence of microalbuminuria and proteinuria did occur, and the positive rate of proteinuria was approximately two times higher in patients with chronic hepatitis C than in those with other forms of liver disease .
Risk Factors For Hepatitis C
Anyone can become infected with the hepatitis C virus. But some people are at a greater risk of infection. Your risk of hepatitis C infection increases if you:
- Received a blood transfusion or solid organ transplants before 1992
- Were born between 1945 and 1965
- Inject illegal drugs
- Have sex with an infected person
- Are exposed to sharp instruments that have been in contact with infected blood
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Check If You Have Hepatitis B
Symptoms of hepatitis B infection include:
- a high temperature
- pain in your upper tummy
- feeling sick or being sick
- patches of raised skin that may be itchy
- yellowing of the skin and whites of the eyes
The infection usually lasts for 1 to 3 months and most people either have no symptoms or mild symptoms. If the infection lasts longer than 6 months it is called chronic hepatitis B.
Can People With Hepatitis C Receive A Kidney Transplant
Individuals living with hepatitis C can receive a kidney transplant, but a medical team will need to consider the risks and benefits of the procedure.
For example, if a person with hepatitis C has significant liver damage, it may be unsafe for them to undergo transplant surgery. However, if they can receive a liver and kidney transplant at the same time, this may make receiving a new kidney possible.
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Types Of Renal Disease Pathology And Presentation
The renal diseases most commonly associated with hepatitis B virus infection include membranous nephropathy, membranoproliferative glomerulonephritis and Polyarteritis nodosa . We earlier reported extrahepatic manifestations of viral hepatitis: 16 patients of 181 chronic hepatitis B patients had renal involvement. Glomerulonephritis was seen in 10 cases of which 8 showed hepatitis B surface and core antigen on the basement membrane and mesangium of glomeruli and liver histology in all of them was chronic hepatitis, while six had PAN.
2.2.1 Membranous nephropathy
It has been proposed that the deposition of HBeAg and anti-HBe immune complexes in the subepithelial region of the glomerular basement membrane is pivotal to disease pathogenesis. HBV-associated secondary membranous nephropathy usually presents with the nephrotic range proteinuria. Immunofluorescent staining and electron microscopy demonstrate granular IgG, C3 and some IgM staining in the subepithelial region along the glomerular basement membrane accompanied by extensive effacement of the podocyte foot processes, and in some cases viral particles in various locations within the glomerulus. The most specific change of the glomerular basement membrane is called âspikeâ formation. These are projections of GBM material between immune complexes that lead to a sawtooth-like appearance of the GBM. This pattern is pathognomonic of full-blown MN.
2.2.3 Polyarteritis nodosa
Renal Dysfunction In Hepatitis B Cirrhosis
|Acute kidney injury||Rise in serum creatinine of â¥50% from baseline or a rise of serum creatinine by â¥26.4 mmol/l in < 48 h HRS type 1 is a specific form of acute kidney injury|
|Chronic kidney disease||Glomerular filtration rate of < 60 ml/min for > 3 mo calculated using MDRD6 formula HRS type 2 is a specific form of chronic kidney disease|
|Acute-on-chronic kidney disease||Rise in serum creatinine of â¥50% from baseline or a rise of serum creatinine by â¥26.4 mmol/l in < 48 h in a patient with cirrhosis whose glomerular filtration rate is < 60 ml/min for > 3 mo calculated using MDRD6 formula|
- HRS, hepatorenal syndrome MDRD6, modification of diet in renal disease formula calculated using six variables of serum creatinine, age, gender, albumin, blood urea nitrogen and whether the patient is African-American.
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Who Are Hepatitis B Carriers
Hepatitis B carriers are people who have the hepatitis B virus in their blood, even though they dont feel sick. Between 6% and 10% of those people whove been infected with the virus will become carriers and can infect others without knowing it. There are over 250 million people in the world who are carriers of HBV, with about 10% to 15% of the total located in India. Children are at the highest risk of becoming carriers. About 9 in 10 babies infected at birth become HBV carriers, and about half of children who are infected between birth and age 5 carry the virus. A blood test can tell you if you are a hepatitis B carrier.
Hepatitis B Vaccination For Kidney Patients
This information is for people who are at increased risk of getting hepatitus B from their kidney condition.
Hepatitis B is an infection of the liver. It is caused by the hepatitis B virus and can be passed on by infected blood or bodily fluids.
You can be protected from hepatitis B infection by a vaccine.
The hepatitis B vaccine consists of a course of injections which contain an inactive hepatitis B virus.
If you have any questions or concerns, please speak to a doctor or nurse caring for you.
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Chronic Hepatitis B Complications
Chronic hepatitis B can lead to
- cirrhosis, a condition in which scar tissue replaces healthy liver tissue and prevents your liver from working normally. Scar tissue also partly blocks the flow of blood through the liver. As cirrhosis gets worse, the liver begins to fail.
- liver failure, in which your liver is badly damaged and stops working. Liver failure is also called end-stage liver disease. People with liver failure may require a liver transplant.
- liver cancer. Your doctor may suggest blood tests and an ultrasound or another type of imaging test to check for liver cancer. Finding cancer at an early stage improves the chance of curing the cancer.
What Standard Precautions Should My Dialysis Care Team Follow To Prevent The Spread Of Infections In The Dialysis Unit
The National Centers for Disease Control and Prevention have developed a set of standard precautions, which should be followed by the dialysis care team in all units. You should be aware of these precautions, and speak to the members of your care team if you have any questions about them.
Your nurse or patient care technician should do the following:
- Wear clean gowns, disposable gloves and face shields or masks and protective eyewear when starting your dialysis treatment and later when disconnecting you from the machine.
- Wear disposable gloves and face shields or masks and protective eyewear when doing any procedures involving your access.
- Change gloves after beginning a treatment, before touching any environmental surface such as dialysis machines, charts and phones, and after each patient contact.
- Wash hands when entering patient areas, before putting on gloves and after removing them.
- Clean and disinfect the treatment area between patient shifts.
- Maintain separate areas for “clean” and “soiled” items.
- Use a separate room and a dedicated dialysis machine and avoid dialyzer reuse for patients who are positive for hepatitis B.
- Do a blood test for hepatitis B and C on all new patients and do routine follow-up testing on susceptible patients.
If you are interested in obtaining a copy of the standard precautions, you can view the web site here.
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Why A Liver Virus Would Damage The Kidney
Damage to the kidney from hepatitis B virus is not usually a result of direct infection. In fact, the immune system’s abnormal reaction to certain parts of the virus may play a larger role in disease causation.
These viral components will typically get attacked by your antibodies in an attempt to fight the infection. Once this happens, the antibodies will bind with the virus, and the resultant debris will get deposited in the kidney. It can then set off an inflammatory reaction, which could cause kidney damage. Hence, rather than the virus directly affecting the kidney, it is your body’s response to it that determines the nature and extent of kidney injury.
Clinical Manifestations And Natural History
Besides MPGN, other forms of glomerular disease have been associated with HCV infection, which include IgA nephropathy, postinfectious glomerulonephritis, membranous nephropathy, thrombotic microangiopathies, focal and segmental glomerulosclerosis , and fibrillary or immunotactoid glomerulopathy . The course of these HCV-associated nephropathies is characterized by remission and relapsing phases.
The long-term outcome of HCV-associated nephropathies remains ill-defined. In a recent retrospective cohort study involving over 470,000 adult veterans, patients with HCV infection were more likely to develop ESRD than HCV-seronegative patients . Moreover, in patients with an estimated glomerular filtration rate â¤30 ml/min per 1.73 m2, the presence of HCV was associated with a nearly threefold higher risk of ESRD. These findings were confirmed by a subsequent cross-sectional study showing that HCV-positive patients had a 40% higher likelihood for developing renal insufficiencyâdefined as serum creatinine levels â¥1.5 mg/dlâcompared with seronegative subjects . Beside the risk of renal disease progression, the overall prognosis for patients with HCV-related nephritis is poor because of a high incidence of co-infections and cardiovascular disease .
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Natural History Of Hcv Infection
Hemodialysis patients are at particular high risk for bloodborne infections because of prolonged vascular access and potential for exposure to contaminated equipment. It has been estimated that, among patients on hemodialysis, the prevalence of HCV infection varies greatly, from less than 5% to nearly 60% according to different areas of the world . Regardless of the geographic location, however, the prevalence is consistently associated with patient age and the number of transfused blood products . Given the introduction of routine screening and heightened attention to prevention of spread, the prevalence of HCV infection has declined in many dialysis centers, and yet it remains unacceptably high, ranging from 8% to 10% even in the most industrialized countries . In European dialysis centers the incidence rate for new-onset HCV infection varies from 0.4% to 16.0% per year . Spontaneous disappearance of HCV RNA has been reported in 1% of untreated dialysis patients .
What Is The Outlook For People With Hepatitis B
The outlook for people with HBV is better now than ever before. You are certainly able to live a full life and help yourself stay healthy. You should make sure to have regular check-ups with a healthcare provider who is qualified to treat hepatitis B, possibly a liver doctor.
Make sure you are vaccinated against hepatitis A. Check with your healthcare provider or pharmacist before taking other medications or over-the-counter products, including supplements and natural products. These could interfere with your medication or damage your liver. For instance, taking acetaminophen in large doses may harm your liver.
Follow the usual guidelines for living a healthy life:
- Eat nutritious foods, choosing from a variety of vegetables, fruits and healthy proteins. It is said that cruciferous vegetables are especially good at protecting the liver.
- Exercise regularly.
- Dont smoke and dont drink. Both tobacco and alcohol are bad for your liver.
- Do things that help you cope with stress, like journaling, talking with others, meditating and doing yoga.
- Avoid inhaling toxic fumes.
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