Impact of Hepatitis C Virus on Renal Transplantation: Association With Poor Survival

Pedroso, Sofía; Martins, La Salete; Fonseca, Isabel; Dias, Leonídio; Henriques, António Castro; Sarmento, António; Cabrita, António

doi:10.1016/j.transproceed.2006.06.065

Cited by 36 publications

(26 citation statements)

References 19 publications

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“…Transplant procedures with HCV are associated with increased viral load and higher ALT levels. 6,7 Similar to the literature, we also found that survival of HCV-positive patients was significantly lower than for non-HCV recipients.…”

Section: Discussionsupporting

confidence: 89%

“…2 Hepatitis C virus in renal recipients has a significant long-term negative effect on patient and renal allograft prognosis, with death from infections significantly higher than among the non-HCV population. 6 Some authors have suggested that immunosuppression facilitates HCV replication and aggravates liver lesions. Transplant procedures with HCV are associated with increased viral load and higher ALT levels.…”

Section: Discussionmentioning

confidence: 99%

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Untitled

2016

Exp Clin Transplant

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Objectives: Chronic hepatitis infection among kidney transplant recipients is not infrequent, with those with hepatitis C virus infection having worse survival. Here, we evaluated liver biopsy changes and its effects on prognosis in kidney transplant recipients. Materials and Methods: Patients with liver biopsies were selected from 1275 kidney transplant recipients who were treated at Başkent University from January 1990 to December 2012. Demographic and clinical findings were evaluated, including age, sex, liver biopsy findings, amyloid and hemosiderin accumulation, and patient survival. Results: Among 1275 renal transplant patients, only 149 patients had liver biopsies. Of 149 patients, 68 patients (45.3%) had liver biopsy only before and 81 patients had liver biopsy after transplant, with 20 of the 81 patients also having biopsy before transplant. The 81 patients who had a liver biopsy after renal transplant were included in the study. In our patient group, mean follow-up was 166 ± 29 months, femaleto-male ratio was 26/55, and mean age was 30.2 ± 9.87 years (range, 15-56 y). Only 2 of 81 liver biopsies (2.4%) were diagnosed as normal or nonspecific. Biopsy findings of the remaining 79 patients (97.6%) showed variable pathologies, including hepatocellular damage and minimal cholestatic changes in 29 patients (35.8%), chronic nonviral hepatitis in 9 (11.1%), and viral hepatitis in 41 (50.6%). The mean time between the first liver biopsy taken before transplant and second biopsy after transplant was 44.5 ± 38.0 months (range, 11-139 mo). Among 81 patients, 6 (7.4%) showed amyloid deposition and 13 (16.0%) showed hemosiderosis. Conclusions:Testing for viral infections is critical in transplant recipients. It is well known that these infections can affect the frequency of rejection episodes and also negatively affect survival in solidorgan transplant recipients. Livers should be evaluated by biopsy even if the variance in liver enzymes or serology is minimal.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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“…9,17,19,25 One study reported a 5-to 22-fold increased risk of dying of infectious diseases. 17 In our experience, the presence of cirrhosis did not lead to an increased likelihood of death or graft loss secondary to infection compared with our HCV þ controls without cirrhosis (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…25 About 40 to 50 of these transplantations are performed annually. 29 Gonwa et al 30 reported that patients who suffered from renal failure after liver transplantation had a 6-year survival rate of 27% if they remained on dialysis.…”

Section: Discussionmentioning

confidence: 99%

Equal 3-Year Outcomes for Kidney Transplantation Alone in HCV-Positive Patients With Cirrhosis

Parsikia

Campos

Khanmoradi

et al. 2015

International Surgery

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Kidney transplantation alone in clinically compensated patients with cirrhosis is not well documented. Current guidelines list cirrhosis as a contraindication for kidney transplantation alone. This is an Institutional Review Board-approved retrospective study. We report our experience with a retrospective comparison between transplants in hepatitis C virus-positive (HCV þ ) patients without cirrhosis and HCV þ patients with cirrhosis. All of the patients were followed for at least a full 3-year period. All of the deaths and graft losses were recorded and analyzed using Kaplan-Meier methodology. One-and three-year cumulative patient survival rates for noncirrhotic patients were 91% and 82%, respectively. For cirrhotic patients, one-and three-year cumulative patient survival rates were 100% and 83%, respectively (P ¼ NS). One-and three-year cumulative graft survival rates censored for death were 94% and 81%, and 95% and 82% for the noncirrhosis and cirrhosis groups, respectively (P ¼ NS). Comparable patient and allograft survival rates were observed when standard kidney allograft recipients were analyzed separately. This study is the longest follow-up document in the literature showing that HCV þ clinically ompensated patients with cirrhosis may undergo kidney transplantation alone as a safe and viable practice.

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“…Rates of HCV positivity in cadaveric kidney donors vary from 1 to 12% worldwide (81). Transplant combination of HCV-positive donor and recipient showed lower graft and patient survival than in the positivenegative donor/recipient combination in most (47,94), but not all, studies (95). Although the risk of patient death is higher in the positive-positive combination, this is, however, lower than that of HCV patients remaining on dialysis (96).…”

Section: Natural History Of Hcv Infectionmentioning

confidence: 93%

Hepatitis C Infection and Chronic Renal Diseases

Perico¹,

Cattaneo²,

Bikbov³

et al. 2009

Clinical Journal of the American Society of Nephrology

189

164

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More than 170 million people worldwide are chronically infected with the hepatitis C virus (HCV), which is responsible for over 1 million deaths resulting from cirrhosis and liver cancers. Extrahepatic manifestations are also relevant and include mixed cryoglobulinemia, lymphoproliferative disorders, and kidney disease. HCV infection is both a cause and a complication of chronic kidney disease, occurring largely in the context of mixed cryoglobulinemia. This infection also represents a major medical and epidemiologic challenge in patients with end-stage renal disease on renal replacement therapy with dialysis or transplantation. In these settings the presence of HCV correlates with higher rates of patient mortality than in HCV-negative subjects on dialysis or undergoing kidney transplant. The major concern is the lack of safe and effective drugs to treat HCV-infected patients with chronic kidney disease. Unfortunately, there are no large-scale clinical trials in this population, especially those receiving renal replacement therapy, so that strong evidence for treatment recommendations is scant. This review article provides the readers with the most recent insights on HCV infection both as cause and complication of chronic kidney disease, discusses pitfalls and limitations of current therapies, and reports on preliminary experience with novel therapeutic agents, as well as directions for future research.

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Impact of Hepatitis C Virus on Renal Transplantation: Association With Poor Survival

Cited by 36 publications

References 19 publications

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Untitled

Equal 3-Year Outcomes for Kidney Transplantation Alone in HCV-Positive Patients With Cirrhosis

Hepatitis C Infection and Chronic Renal Diseases

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