title: 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.affiliation: Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL 33136, USA. droth@med.miami.edu
authors.forename: David
authors.initials: D
authors.lastname: Roth
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Gaynor
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ciancio
authors.forename: Junichiro
authors.initials: J
authors.lastname: Sageshima
authors.forename: Warren
authors.initials: W
authors.lastname: Kupin
authors.forename: Giselle
authors.initials: G
authors.lastname: Guerra
authors.forename: Linda
authors.initials: L
authors.lastname: Chen
authors.forename: George W
authors.initials: GW
authors.lastname: Burke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002648:Child; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult