Kidney Transplantation Alone in ESRD Patients With Hepatitis C Cirrhosis

Paramesh, Anil; Davis, John Y.; Mallikarjun, Chaitanya; Zhang, Rubin; Cannon, Robert M.; Shores, Nathan J.; Killackey, Mary; McGee, Jennifer; Saggi, Bob H.; Slakey, Douglas P.; Balart, Luis A.; Buell, Joseph F.

doi:10.1097/tp.0b013e318255f890

Cited by 39 publications

(35 citation statements)

References 20 publications

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“…In their study the negative prognosticators included recipient age and albumin level. 24 They concluded that KTA may be safe in patients with HCV þ compensated cirrhosis. Their average follow-up was 32 months.…”

Section: Discussionmentioning

confidence: 99%

Equal 3-Year Outcomes for Kidney Transplantation Alone in HCV-Positive Patients With Cirrhosis

Parsikia

Campos

Khanmoradi

et al. 2015

International Surgery

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Kidney transplantation alone in clinically compensated patients with cirrhosis is not well documented. Current guidelines list cirrhosis as a contraindication for kidney transplantation alone. This is an Institutional Review Board-approved retrospective study. We report our experience with a retrospective comparison between transplants in hepatitis C virus-positive (HCV þ ) patients without cirrhosis and HCV þ patients with cirrhosis. All of the patients were followed for at least a full 3-year period. All of the deaths and graft losses were recorded and analyzed using Kaplan-Meier methodology. One-and three-year cumulative patient survival rates for noncirrhotic patients were 91% and 82%, respectively. For cirrhotic patients, one-and three-year cumulative patient survival rates were 100% and 83%, respectively (P ¼ NS). One-and three-year cumulative graft survival rates censored for death were 94% and 81%, and 95% and 82% for the noncirrhosis and cirrhosis groups, respectively (P ¼ NS). Comparable patient and allograft survival rates were observed when standard kidney allograft recipients were analyzed separately. This study is the longest follow-up document in the literature showing that HCV þ clinically ompensated patients with cirrhosis may undergo kidney transplantation alone as a safe and viable practice.

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Section: Discussionmentioning

confidence: 99%

Equal 3-Year Outcomes for Kidney Transplantation Alone in HCV-Positive Patients With Cirrhosis

Parsikia

Campos

Khanmoradi

et al. 2015

International Surgery

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“…Good survival rates have been obtained in these patients, especially if they have minimal or well-controlled liver disease 35. In patients undergoing renal transplantation in the setting of established cirrhosis and a hepatic portal venous gradient (HPVG) below 10 mmHg, a combined liver-kidney transplantation may be unnecessary and a kidney transplant alone may be safely performed 36,37…”

Section: Hcv Infection In Kidney Transplant Recipientsmentioning

confidence: 99%

Management of chronic hepatitis C virus infection in patients with end-stage renal disease: a review

Valadez

Juárez

Pedrero

et al. 2015

TCRM

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Infection with hepatitis C virus (HCV) is highly prevalent in chronic kidney disease (CKD) patients, mainly in those on hemodialysis (HD). The seroprevalence of HCV in developing countries ranges between 7% and 40%. Risk factors for this infection in the CKD population include the number of blood transfusions, duration of end-stage renal disease (ESRD), and prevalence of HCV in HD. Chronic HCV infection in patients with ESRD is associated with an increase in morbidity and mortality in the pre and post kidney transplant periods. The increase in mortality is directly associated with liver complications and an elevated cardiovascular risk in HCV-infected patients on hemodialysis. Antiviral treatment may improve the prognosis of patients with HCV, and standard interferon remains the cornerstone of treatment. Treatment of HCV in patients with CKD is complex, but achieving a sustained viral response may decrease the frequency of complications after transplantation. It appears that HCV-infected patients who remain on maintenance dialysis are at increased risk of death compared with HCV patients undergoing renal transplantation.

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“…The authors concluded that kidney alone transplant may be safe in ESKD patients with compensated HCV cirrhosis and HPVG of less than 10 mmHg. (Paramesh et al, 2012). While limited studies suggest that combined liver-kidney transplant may be unnecessary in ESKD patients with compensated HCV cirrhosis and HPVG of less than 10 mmHg, patients with decompensated liver cirrhosis should be referred for combined liver-kidney transplant.…”

Section: Infectionsmentioning

confidence: 99%

Medical Evaluation of the Adult Kidney Transplant Candidate

Pham¹,

Pham²,

Pham³

et al. 2013

Current Issues and Future Direction in Kidney Transplantation

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Kidney Transplantation Alone in ESRD Patients With Hepatitis C Cirrhosis

Abstract: Our study suggests that KTx alone may be safe in patients with compensated HCV, cirrhosis, and ESRD with HPVG less than 10 mm Hg. A simultaneous liver-kidney transplantation may be an unnecessary use of a liver allograft in these patients.

Cited by 39 publications

References 20 publications

Equal 3-Year Outcomes for Kidney Transplantation Alone in HCV-Positive Patients With Cirrhosis

Equal 3-Year Outcomes for Kidney Transplantation Alone in HCV-Positive Patients With Cirrhosis

Management of chronic hepatitis C virus infection in patients with end-stage renal disease: a review

Medical Evaluation of the Adult Kidney Transplant Candidate

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