Kidney transplantation alone in ESRD patients with hepatitis C cirrhosis.
BACKGROUND
Kidney transplantation (KTx) alone in patients with cirrhosis and renal failure (end-stage renal disease [ESRD]) infected with hepatitis C virus (HCV) is controversial. The aim of this study was to compare outcomes of HCV+ patients with ESRD and cirrhosis (C group) versus HCV+ patients with ESRD but with no cirrhosis (NC group) listed for KTx.


METHODS
Ninety HCV+ patients with ESRD were evaluated for KTx between 2003 and 2010. Listed patients underwent transjugular liver biopsy with hepatic portal venous gradient (HPVG) measurements. Only patients with HPVG less than 10 mm Hg were considered for KTx alone. We analyzed patient demographics, waitlist/liver disease characteristics, and posttransplant outcomes between groups.


RESULTS
Sixty-four patients listed for KTx alone were studied. Twelve patients (18.75%) showed biopsy-proven cirrhosis. Thirty-seven patients underwent KTx alone (9 from C and 28 from NC). No patients developed decompensation of their liver disease, although one patient for NC group developed metastatic hepatocellular carcinoma 16 months after transplantation. One- and three-year graft survival rates were 75% and 75% versus 92.1% and 75.1% for groups C and NC, respectively (P=0.72). One- and three-year patient survival rates were 88.9% and 88.9% versus 96.3% and 77.9% for groups C and NC, respectively (P=0.76). Only increasing recipient age and decreasing albumin levels were significantly associated with worse graft and patient survival.


CONCLUSIONS
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.
Tulane Transplant Institute, Tulane University School of Medicine, New Orleans, LA, USA. aparames@tulane.edu
Anil S
AS
Paramesh
John Y
JY
Davis
Chaitanya
C
Mallikarjun
Rubin
R
Zhang
Robert
R
Cannon
Nathan
N
Shores
Mary T
MT
Killackey
Jennifer
J
McGee
Bob H
BH
Saggi
Douglas P
DP
Slakey
Luis
L
Balart
Joseph F
JF
Buell
D000328:Adult; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D005260:Female; D005355:Fibrosis / Q000150:complications* / Q000628:therapy* / Q000821:virology; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications* / Q000628:therapy* / Q000821:virology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy* / Q000821:virology; D016030:Kidney Transplantation / Q000379:methods*; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D016896:Treatment Outcome