Kidney Transplantation Alone in End-Stage Renal Disease Patients With Hepatitis B Liver Cirrhosis

Abstract

Kidney transplantation alone may be safe in patients with compensated hepatitis B virus LC.

Hepatitis B in renal transplant patients

“…A recent single center study provided data of an excellent five-year survival rate (94%) in 12 cirrhotic patients with hepatitis B after kidney transplantation alone[ 16 ].…”

Clinical practice guidelines for the provision of renal service in Hong Kong: Potential Kidney Transplant Recipient Wait‐listing and Evaluation, Deceased Kidney Donor Evaluation, and Kidney Transplant Postoperative Care

“…Compensated liver cirrhosis secondary to HBV, on the other hand, is not necessarily a contraindication to kidney transplantation alone, in the current era of pre‐emptive or prophylactic antiviral therapy. A recent single‐centre Korean study reported good outcome of kidney transplantation alone in 12 patients (8 with Child‐Pugh class A and 4 with class B) between 1997 and 2011. Liver function worsened in only one of these patients and hepatocellular carcinoma was diagnosed in four patients after a median period of 35 months.…”

“…Liver function worsened in only one of these patients and hepatocellular carcinoma was diagnosed in four patients after a median period of 35 months. Five‐year patient survival was 100% . However, kidney transplantation alone should not be recommended for HBV patients with decompensated cirrhosis, or those with compensated cirrhosis and portal hypertension.…”

“…Similar to HBV scenario, liver biopsy is in general recommended to assess degree of liver damage before decision on kidney transplantation alone versus combined liver‐kidney transplantation . It is unclear whether non‐invasive markers such as elastography can replace liver biopsy evaluation of HCV, partly because of the high sustained virological response rate of direct‐acting antiviral drugs (DAA) . Because of the rapidly emerging data on DAA targeting viral proteins, we recommend collaboration with hepatologists for joint‐decision.…”

Editorial: when cirrhosis deserves haemodialysis—rethinking strategies. Authors’ reply

“…We observed, in a recent study of HCV kidney transplant recipients, that kidney transplantation alone in patients with compensated cirrhosis is problematic when considering their 5‐ and 10‐year survival at 71% (personal data) and 16.4% . This latter result may be explained by the fact that the risk of hepatocellular carcinoma and liver decompensation remains significant and could even be increased by immunosuppressive regimen . Thus, strict screening of hepatocellular carcinoma and evaluation of liver function are crucial in kidney recipients with compensated cirrhosis .…”