Effect of kidney transplantation on outcomes among patients with hepatitis C

David Roth, Jeffrey J. Gaynor, K. Rajender Reddy, Gaetano Ciancio, Junichiro Sageshima, Warren Kupin, Giselle Guerra, Linda Chen, George W. Burke

Research output: Contribution to journalArticle

110 Scopus citations

Abstract

The long-term outcome of kidney transplantation in patients infected with hepatitis C virus (HCV) and end stage renal disease (ESRD) is not well described. We retrospectively identified 230 HCV-infected patients using enzyme immunoassay and nucleic acid testing obtained during the transplant evaluation. Of 207 patients who had a liver biopsy before transplant, 44 underwent 51 follow-up liver biopsies at approximately 5-year intervals either while on the waitlist for a kidney or after kidney transplantation. Advanced fibrosis was present in 10% of patients biopsied, identifying a population that may warrant consideration for combined liver-kidney transplantation. Kidney transplantation does not seem to accelerate liver injury; 77% of kidney recipients who underwent follow-up biopsies showed stable or improved liver histology. There was a higher risk for death during the first 6 months after transplant, but undergoing transplantation conferred a long-term survival advantage over remaining on the waitlist, which was evident by 6 months after transplant (HR, 0.32; 95% CI, 0.17 to 0.62). Furthermore, the risk for death resulting from infection was significantly higher during the first 6 months after transplant (HR, 26.6; 95% CI, 5.01 to 141.3), whereas there was an early (≤6 months) and sustained decrease in the risk for cardiovascular death (HR, 0.20; 95% CI, 0.08 to 0.47). In summary, these data suggest the importance of liver biopsy before transplant and show that kidney transplantation confers a long-term survival benefit among HCV-infected patients with ESRD compared with remaining on the waitlist. Nevertheless, the higher incidence of early infection-related deaths after transplant calls for further study to determine the optimal immunosuppressive protocol.

Original languageEnglish (US)
Pages (from-to)1152-1160
Number of pages9
JournalJournal of the American Society of Nephrology
Volume22
Issue number6
DOIs
StatePublished - Jun 1 2011
Externally publishedYes

ASJC Scopus subject areas

  • Nephrology

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    Roth, D., Gaynor, J. J., Reddy, K. R., Ciancio, G., Sageshima, J., Kupin, W., Guerra, G., Chen, L., & Burke, G. W. (2011). Effect of kidney transplantation on outcomes among patients with hepatitis C. Journal of the American Society of Nephrology, 22(6), 1152-1160. https://doi.org/10.1681/ASN.2010060668