title: Kidney transplantation threshold in patients with hepatitis C: a decision analysis model.
abstract: BACKGROUND
  There are no standard guidelines for the permissible degree of liver fibrosis in patients with chronic hepatitis C virus prohibiting cadaveric renal transplantation (CRT).
  
  
  METHODS
  A decision analysis model was constructed to compare 5-year patient survival using three strategies for patients on hemodialysis. The probabilities of pretransplant and posttransplant survival, progression of liver fibrosis, CRT, and sustained viral response were obtained from a systematic review of the literature. Sensitivity analyses were performed.
  
  
  RESULTS
  Kidney transplantation was associated with improved 5-year survival for patients with fibrosis stages 1 to 3, but not stage 4 (cirrhosis). Antiviral therapy was associated with improvement in survival in patients with stage 3 fibrosis. The 5-year survival was similar for patients with stage 4 irrespective of the option of antiviral therapy. The model was sensitive to varying the probability of both pretransplant and posttransplant survival.
  
  
  CONCLUSIONS
  There appears to be no overall 5-year survival benefit in treating S1 and S2 fibrosis patients with hepatitis C virus antiviral therapy before CRT. There is no benefit in overall 5-year survival in patients with cirrhosis and thus should not be candidates for CRT.
authors.affiliation: 1 Department of Medicine, University of California, Los Angeles, CA. 2 Department of Surgery, University of California, Los Angeles, CA.
authors.forename: Gina
authors.initials: G
authors.lastname: Choi
authors.forename: Kristina G
authors.initials: KG
authors.lastname: Lee
authors.forename: Crystal
authors.initials: C
authors.lastname: Wu
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003661:Decision Support Techniques; D018450:Disease Progression; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000821:virology; D018579:Patient Selection; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents