Effect of kidney transplantation on outcomes among patients with hepatitis C.

Abstract

The long-term outcome of kidney transplantation in patients infected with hepatitis C virus (HCV) and end stage renal disease (ESRD) is not well described. We retrospectively identified 230 HCV-infected patients using enzyme immunoassay and nucleic acid testing obtained during the transplant evaluation. Of 207 patients who had a liver biopsy before transplant, 44 underwent 51 follow-up liver biopsies at approximately 5-year intervals either while on the waitlist for a kidney or after kidney transplantation. Advanced fibrosis was present in 10% of patients biopsied, identifying a population that may warrant consideration for combined liver-kidney transplantation. Kidney transplantation does not seem to accelerate liver injury; 77% of kidney recipients who underwent follow-up biopsies showed stable or improved liver histology. There was a higher risk for death during the first 6 months after transplant, but undergoing transplantation conferred a long-term survival advantage over remaining on the waitlist, which was evident by 6 months after transplant (HR, 0.32; 95% CI, 0.17 to 0.62). Furthermore, the risk for death resulting from infection was significantly higher during the first 6 months after transplant (HR, 26.6; 95% CI, 5.01 to 141.3), whereas there was an early (≤6 months) and sustained decrease in the risk for cardiovascular death (HR, 0.20; 95% CI, 0.08 to 0.47). In summary, these data suggest the importance of liver biopsy before transplant and show that kidney transplantation confers a long-term survival benefit among HCV-infected patients with ESRD compared with remaining on the waitlist. Nevertheless, the higher incidence of early infection-related deaths after transplant calls for further study to determine the optimal immunosuppressive protocol.

• Authors: David Roth, Jeffrey J Gaynor, K Rajender Reddy, Gaetano Ciancio, Junichiro Sageshima, Warren Kupin, Giselle Guerra, Linda Chen, George W Burke 3rd
• Journal: Journal of the American Society of Nephrology : JASN (J Am Soc Nephrol) Vol. 22 Issue 6 Pg. 1152-60 (Jun 2011) ISSN: 1533-3450 [Electronic] United States
• PMID: 21546575 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Biopsy
• Child
• Comorbidity
• Female
• Follow-Up Studies
• Hepatitis C (epidemiology, mortality, surgery)
• Humans
• Kidney (pathology)
• Kidney Failure, Chronic (epidemiology, mortality, surgery)
• Kidney Transplantation (pathology)
• Longitudinal Studies
• Male
• Middle Aged
• Retrospective Studies
• Survival Rate
• Treatment Outcome
• Young Adult