Is it time to rethink combined liver-kidney transplant in hepatitis C patients with advanced fibrosis?

Shah NJ, Russo MW, et al.

Niraj James Shah, Department of Medicine, Division of Digestive Diseases, the University of Mississippi Medical Center, Jackson, MS 39216, United States.

World journal of hepatology. Feb 2017.

To reduce hepatic and extrahepatic complications of chronic hepatitis C in kidney transplant recipients.We conducted a systematic review of kidney only transplant in patients with hepatitis C and advanced fibrosis.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.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.


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