title: Is it time to rethink combined liver-kidney transplant in hepatitis C patients with advanced fibrosis?
abstract: OBJECTIVE
  To reduce hepatic and extrahepatic complications of chronic hepatitis C in kidney transplant recipients.
  
  
  METHODS
  We conducted a systematic review of kidney only transplant in patients with hepatitis C and advanced fibrosis.
  
  
  RESULTS
  The 5 year patient survival of kidney transplant recipients with and without hepatitis C cirrhosis ranged from 31% to 90% and 85% to 92%, respectively. Hepatitis C kidney transplant recipients had lower 10-year survival when compared to hepatitis B patients, 40% and 90% respectively. There were no studies that included patients with virologic cure prior to kidney transplant that reported post-kidney transplant outcomes. There were no studies of direct acting antiviral therapy and effect on patient or graft survival after kidney transplantation.
  
  
  CONCLUSIONS
  Data on kidney transplant only in hepatitis C patients that reported inferior outcomes were prior to the development of potent direct acting antiviral. With the development of potent directing acting antiviral therapy for hepatitis C with high cure rates studies are needed to determine if patients with hepatitis C, including those with advanced fibrosis, can undergo kidney transplant alone with acceptable long term outcomes.
authors.affiliation: Niraj James Shah, Department of Medicine, Division of Digestive Diseases, the University of Mississippi Medical Center, Jackson, MS 39216, United States.
authors.forename: Niraj James
authors.initials: NJ
authors.lastname: Shah
authors.affiliation: Niraj James Shah, Department of Medicine, Division of Digestive Diseases, the University of Mississippi Medical Center, Jackson, MS 39216, United States.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Russo
keywords: Cirrhosis/cirrhotics; Graft outcomes; Kidney transplantation; Meta-analysis; Mortality; Renal transplantation; Systematic review