Long-Term Experience With Kidney Transplantation From Hepatitis C-Positive Donors Into Hepatitis C-Positive Recipients

Abstract

Kidney transplantation from hepatitis C virus (HCV)antibody positive donors (HCVD+) into HCV antibody positive recipients (HCVR+) is controversial. We implemented this policy in our units in 1990. Herein, we report the long-term safety of this strategy. From March 1990 to March 2007, 162 HCVR+ received a kidney from HCVD+ (group 1) and 306 from HCVD− (group 2) in our units. Mean follow-up was 74.5 months. Five-and 10-year patient survival was 84.8% and 72.7% in group 1 vs. 86.6% and 76.5% in group 2 (p = 0.250). Three deaths in group 1 and two in group 2 were liver-disease related. Five-and 10-year graft survival was 58.9% and 34.4% versus 65.5% and 47.6% respectively (p = 0.006) while death-censored graft survival was 69% and 47% versus 72.7% and 58.5% (p = 0.055). Decompensated chronic liver disease was similar: 10.3% versus 6.2%. Cox-regression analysis could not identify the donor's HCV serology as a significant risk factor for death, graft failure and severe liver disease in HCVR+. In conclusion, long-term outcome of HCVR+ transplanted with kidneys from HCVD+ seems good in terms of patient survival, graft survival and liver disease. HCVD+ was not a significant risk factor for mortality, graft failure and liver disease among HCVR+. These data strongly suggest that the use of kidneys from HCVD+ in HCVR+ is a safe long-term strategy that helps to prevent kidney loss.

Effect of HCV, HIV and Coinfection in Kidney Transplant Recipients: Mate Kidney Analyses

“…In isolation, HCVþ patients have significantly lower patient and graft survival compared with HCV seronegative transplant recipients both in our analysis and according to many other studies (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). It has been suggested that the pattern of renal pathologic injury in HCVþ KTX patients derives from overlapping pathways: one mediated by HCV PCRþ infection itself and the other one related to enhanced cellular and humoral immune responses observed in the HCV-infected transplant population (24).…”

“…Despite a survival advantage over dialysis, reports of outcomes among kidney transplant recipients with HCVþ compared to those without hepatitis C virus (HCVÀ) are often conflicting. Whereas many studies have shown a detrimental effect of HCVþ on kidney transplant graft survival relative to HCVÀ recipients, others have not found a difference (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Interpretation of many of these reports is limited by various methodological issues.…”

Mortality, Hospitalization, and Quality of Life among Patients with Hepatitis C Infection on Hemodialysis

“…Literature reports of treatment rates for HCV infection are rare. We are aware of a single report that mentioned that only 49 of 545 patients on HD had received IFN for HCV infection before renal transplantation (34). Treatment rates appear to be much higher in the non-CKD population-about 22%-28% in the United States and United Kingdom (35,36).…”

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

“…20 In many large reports of HCV þ recipients, the liver is not histologically monitored or patients with cirrhosis are excluded outright. 9,21 Current recommendations to evaluate for combined kidney-liver transplantations in CCCs may not be the most appropriate allocation of resources. 6,7 In addition, the benefits of combined (prophylactic) liver and kidney transplantation in CCCs would have to be weighed against the added risk of performing OLT.…”