Long-term impact of renal transplantation on liver fibrosis during hepatitis C virus infection

Alric, Laurent; Dimartino, V; Selves, Janik; Cacoub, Patrice; Charlotte, Frédéric; Reynaud, Didier; Piette, Jean‐Charles; Péron, Jean‐Marie; Vinel, Jean–Pierre; Durand, Dominique; Izopet, Jacques; Poynard, Thierry; Duffaut, M; Rostaing, Lionel

doi:10.1053/gast.2002.36610

Cited by 111 publications

(72 citation statements)

References 20 publications

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“…Data in the dialysis population are scant, and there are conflicting results from studies examining sequential posttransplant biopsies without the benefit of pretransplant samples. Using a matched immunocompetant control group, Zylberberg et al 39 reported more rapid progression of liver fibrosis in renal transplant recipients, whereas Alric et al 40 found just the opposite, with slower progression in the transplanted cohort. Interestingly, Kamar et al 41 reported variable outcomes including progression, stability, and even improvement in liver fibrosis among patients who underwent more than one post-transplant liver biopsy.…”

Section: Discussionmentioning

confidence: 98%

Effect of Kidney Transplantation on Outcomes among Patients with Hepatitis C

Roth¹,

Gaynor

Reddy³

et al. 2011

Journal of the American Society of Nephrology

129

128

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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 (Յ6 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.

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Section: Discussionmentioning

confidence: 98%

Effect of Kidney Transplantation on Outcomes among Patients with Hepatitis C

Roth¹,

Gaynor

Reddy³

et al. 2011

Journal of the American Society of Nephrology

129

128

View full text Add to dashboard Cite

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“…A more recent analysis of the UNOS database provides evidence of a small survival benefit with induction therapy regardless of recipient HCV status (29). Among kidney transplant recipients who have not undergone prior non-renal transplant, immunosuppression increased HCV replication, although recent studies have shown relatively slow progression of liver fibrosis (30)(31)(32)(33). Despite conflicting data, most studies show worse graft and patient survival in HCV+ compared with HCV2 kidney recipients with higher rates of infections and death among the HCV+ kidney recipients (34)(35)(36)(37).…”

Section: Discussionmentioning

confidence: 99%

The Influence of Induction Therapy for Kidney Transplantation after a Non-Renal Transplant

Cassuto¹,

Levine²,

Reese

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Non-renal transplant recipients who subsequently develop ESRD and undergo kidney transplantation are medically and immunologically complex due to comorbidities, high cumulative exposure to immunosuppressants, and sensitization to alloantigen from the prior transplant. Although prior non-renal transplant recipients are one of the fastest growing segments of the kidney wait list, minimal data exist to guide the use of antibody induction therapy (IT+) at the time of kidney after lung (KALu), heart (KAH), and liver (KALi) transplant.Design, setting, participants, & measurements This retrospective cohort study used national registry data to examine IT use and survival after kidney transplantation. Separate multivariate Cox regression models were constructed to assess patient survival for IT+ and IT2 KALu (n=232), KAH (n=588), and KALi (n=736) recipients.

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“…Sterling et al (15) have also reported that inflammatory activity and fibrosis were less intense in HD patients, although these differences were restricted to patients with elevated ALT as observed in our patients. In addition, HD patients have been described to have less advanced fibrosis and a lower degree of liver inflammation when compared with chronic renal failure patients not requiring dialysis (13,20) or to patients who underwent renal transplantation (19,21,22).…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C Is Less Aggressive in Hemodialysis Patients than in Nonuremic Patients

Trevizoli

Menezes²,

Velasco³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: The severity of liver disease among hepatitis C patients on hemodialysis is controversial. The aim of this study was to compare the clinical, biochemical, and liver histologic characteristics of hepatitis C virus (HCV) in hemodialysis patients and in those with normal renal function.Design, setting, participants, & measurements: A case-control study was carried out with 36 HCV patients on hemodialysis and 37 HCV patients with normal renal function matched for gender, age at infection, and estimated time of infection.Results: HCV patients on hemodialysis had lower levels of alanina aminotransferase and lower viral load. Hepatic fibrosis was significantly higher in the patients with normal renal function (73%) than in hemodialysis patients (47.2%, P < 0.025); the same was observed for inflammatory activity (control group 59.5% versus hemodialysis patients 27.7%, P ‫؍‬ 0.003). In addition, the risk of tissue inflammation was four times lower in hemodialysis patients (odds ratio ‫؍‬ 0.23, P < 0.004), and severe inflammatory activity on biopsy was the only independent risk factor for fibrosis (P < 0.001).Conclusions: The lower biochemical and inflammatory activities observed in hemodialysis patients suggest that hemodialysis and uremia may have a protective role against progression of the disease caused by HCV.

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Long-term impact of renal transplantation on liver fibrosis during hepatitis C virus infection

Cited by 111 publications

References 20 publications

Effect of Kidney Transplantation on Outcomes among Patients with Hepatitis C

Effect of Kidney Transplantation on Outcomes among Patients with Hepatitis C

The Influence of Induction Therapy for Kidney Transplantation after a Non-Renal Transplant

Hepatitis C Is Less Aggressive in Hemodialysis Patients than in Nonuremic Patients

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