*Purpose: Hepatitis B virus (HBV) infection of kidney transplantation (KT) recipients is associated with increased overall mortality and progression of liver disease after KT. Liver biopsy is the gold standard for hepatic diagnosis, but it is an invasive procedure. This study assessed whether liver biopsy is necessary when deciding transplant candidacy for hepatitis B virus positive living donor kidney transplant recipients.

*Methods: Outcomes were analyzed in 144 Hepatitis B surface antigen (HbsAg) positive patients with end stage renal disease (ESRD) who underwent liver biopsy. To compare the clinical characteristics according to the pathology, we classified patients according to the degree of fibrosis based on METAVIR score.

*Results: Pathologic findings without fibrosis (F0) were found in 65 (49.6%) patients and 79 (50.4%) patients were had fibrosis scores ranging from F1 to F4. There was no liver failure after KT in non-fibrosis patients and 4 (5.1%) fibrosis patients progressed to liver failure (P = 0.127). Hepatocellular carcinoma was diagnosed in 2 (3.1%) non-fibrosis patients and in 6 (7.6%) fibrosis patients (P = 0.294). Biopsy confirmed acute rejection occurred in 12 (18.5%) non-fibrosis cases and in 22 (27.8%) fibrosis cases (P = 0.187). The 5-year graft survival rate was 96.9% in non-fibrosis patients and 94.6 % in fibrosis patients. There was no significant differences in graft and patient survival between patients with or without fibrosis (P = 0.381 and P = 0.113 by log-rank test, respectively, Figure 1 and 2).

*Conclusions: Liver biopsy might not be helpful when deciding treatment for HBsAg positive KT candidates.

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