Severe evolution of chronic hepatitis C in renal transplantation: a case control study

Zylberberg, Hervé; Nalpas, Bertrand; Carnot, Françoise; Skhiri, H.; Fontaine, Hélène; Legendre, Christophe; Kreis, Henri; Bréchot, Christian; Pol, Stanislas

doi:10.1093/ndt/17.1.129

Cited by 121 publications

(70 citation statements)

References 31 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

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“…Thus, protocol liver biopsies within 6-12 months of transplantation, with subsequent biopsies based on clinical course, are required for evaluation of liver disease after transplantation (53). The prevalence of cirrhosis has been reported to be 5%-21% after 3-7 years of follow-up (56,57). In one study of sequential liver biopsies in 51 kidney transplant recipients every 3-4 years, 40% of the patients had progression of fibrosis, 40% had stable levels of fibrosis, and 20% showed regression of fibrosis .10 years after transplantation (58).…”

Section: Hcv Infectionmentioning

confidence: 99%

Common Infections in Kidney Transplant Recipients

Karuthu¹,

Blumberg

2012

Clinical Journal of the American Society of Nephrology

221

148

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SummaryInfections are a major cause of morbidity and mortality in kidney transplant recipients. To some extent, these may be preventable. Careful pretransplant screening, immunization, and post-transplant prophylactic antimicrobials may all reduce the risk for post-transplant infection. However, because transplant recipients may not manifest typical signs and symptoms of infection, diagnoses may be confounded. Furthermore, treatment regimens may be complicated by drug interactions and the need to maintain immunosuppression to avoid allograft rejection. This article reviews common post-transplant infections, including prophylactic, diagnostic, and treatment strategies, providing guidance regarding care of kidney transplant patients with infection.

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“…In several studies where paired liver biopsies were done pre-and posttransplant, the rate of HCV-related fibrosis has been shown to be accelerated in renal transplant recipients when compared to immunocompetent individuals (10,11). When these data are examined more closely, however, the risk of accelerated progression of fibrosis and development of end-stage liver disease and its complications appear to be limited largely to those with advanced fibrosis or cirrhosis at the time of transplant (4,6,9,11).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Lung Transplantation in Recipients With Hepatitis C Virus Infection

Doucette

Halloran

Kapasi

et al. 2016

American Journal of Transplantation

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Hepatitis C virus (HCV) infection negatively impacts patient and graft survival following nonhepatic solid organ transplantation. Most data, however, are in kidney transplant, where despite modest impact on outcomes, transplantation is recommended for those with mild to moderate hepatic fibrosis given overall benefit compared to remaining on dialysis. In lung transplantation (LuTx), there is little data on outcomes and international guidelines are vague on the criteria under which transplant should be considered. The University of Alberta Lung Transplant Program routinely considers patients with HCV for lung transplant based on criteria extrapolated from the kidney transplant literature. Here we describe the outcomes of 27 HCV-positive, compared to 443 HCV-negative LuTx recipients. Prior to transplant, five patients were treated for HCV and cured. At the time of transplant, 14 patients remained HCV RNA positive. The 1-, 3-, and 5-year survival were similar in HCV RNApositive versus -negative recipients at 93%, 77%, and 77% versus 86%, 75%, and 66% (p = 0.93), respectively. Long-term follow-up in eight patients demonstrated no significant progression of fibrosis. In our cohort, HCV did not impact LuTx outcomes and in the era of interferon-free HCV therapies this should not be a barrier to LuTx.

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Severe evolution of chronic hepatitis C in renal transplantation: a case control study

Cited by 121 publications

References 31 publications

Effect of Kidney Transplantation on Outcomes among Patients with Hepatitis C

Effect of Kidney Transplantation on Outcomes among Patients with Hepatitis C

Common Infections in Kidney Transplant Recipients

Outcomes of Lung Transplantation in Recipients With Hepatitis C Virus Infection

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