Kidney Transplantation Alone in ESRD Patients With Hepatitis C Cirrhosis
| Autor: | Jennifer McGee, Bob H. Saggi, Chaitanya Mallikarjun, Rubin Zhang, Luis A. Balart, Nathan Shores, Joseph F. Buell, Mary Killackey, Douglas P. Slakey, Anil Paramesh, Robert M. Cannon, John Y. Davis |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Carcinoma Hepatocellular Cirrhosis Biopsy Hepatitis C virus medicine.disease_cause Gastroenterology Liver disease Internal medicine Carcinoma medicine Humans Decompensation Neoplasm Metastasis Kidney transplantation Retrospective Studies Transplantation business.industry Graft Survival Liver Neoplasms Hepatitis C Middle Aged medicine.disease Fibrosis Kidney Transplantation Treatment Outcome Liver Kidney Failure Chronic Female business |
| Zdroj: | Transplantation. 94:250-254 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0b013e318255f890 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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