Short and long term outcome of kidney transplanted patients with chronic viral hepatitis B and C

Ridruejo, Ezequiel; Díaz, Carlos; Michel, Mario Davalos; Pujol, Gervasio Soler; Martínez, Alfredo P.; Marciano, Sebastián; Mandó, Oscar G.; Vilches, Antonio

doi:10.1016/s1665-2681(19)31636-9

Cited by 19 publications

(14 citation statements)

References 42 publications

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“…Our electronic and manual searches identified 1022 studies, of which 171 were considered potentially relevant and were selected for full text review. Nineteen papers fulfilled the inclusion criteria and 152 were excluded. The trials by Pereira et al .…”

Section: Resultsmentioning

confidence: 99%

Meta‐analysis of observational studies: hepatitis C and survival after renal transplant

Fabrizi

Martin

Dixit

et al. 2013

Journal of Viral Hepatitis

128

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Recent evidence has shown that anti-HCV-positive serologic status is significantly linked to lower patient and graft survival after renal transplant, but conflicting results have been given on this point. The aim of this study was to conduct a systematic review of the published medical literature concerning the impact of HCV infection on all-cause mortality and graft loss after RT. The relative risk of all-cause mortality and graft loss was regarded as the most reliable outcome end-point. Study-specific relative risks were weighted by the inverse of their variance to obtain fixed- and random-effect pooled estimates for mortality and graft loss with HCV across the published studies. We identified eighteen observational studies involving 133 530 unique renal transplant recipients. The summary estimate for adjusted relative risk (aRR) of all-cause mortality was 1.85 with a 95% confidence interval (CI) of 1.49; 2.31 (P < 0.0001); heterogeneity statistics, Ri = 0.87 (P-value by Q-test = 0.001). The overall estimate for adjusted RR of all-cause graft loss was 1.76 (95% CI, 1.46; 2.11) (P < 0.0001), heterogeneity statistics, Ri = 0.65 (P-value by Q-test = 0.001). Stratified analysis did not change meaningfully these results. Meta-regression showed that living donor rate had a favourable influence on patient (P = 0.031) and graft survival (P = 0.01), whilst diabetes mellitus having a detrimental role on patient survival (P = 0.001). This meta-analysis of observational studies supports the notion that HCV-positive patients after RT have an increased risk of mortality and graft loss. Further studies are in progress to understand better the mechanisms underlying the relationship between HCV and mortality or graft dysfunction after renal transplant.

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Section: Resultsmentioning

confidence: 99%

Meta‐analysis of observational studies: hepatitis C and survival after renal transplant

Fabrizi

Martin

Dixit

et al. 2013

Journal of Viral Hepatitis

128

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“…Most studies show a higher mortality in renal transplant recipients infected with HBV, compared with renal transplant recipients without HBV infection, although this topic is still under debate [34][35][36]. This higher mortality is related to liver disease and is associated with a more frequent and more rapid progression to cirrhosis and hepatocellular carcinoma, probably because the immunosuppressive regimen enhances viral replication [37,38].…”

Section: Hepatitis B Virusmentioning

confidence: 99%

VIRAL hepatitis in solid organ transplantation other than liver

Vallet-Pichard¹,

Fontaine²,

Mallet³

et al. 2011

Journal of Hepatology

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Transplantation is the best treatment for end-stage organ failure. Hepatitis virus infections, mainly hepatitis B virus (HBV) and hepatitis C virus (HCV) infections still constitute a major problem because they are common in allograft recipients and are a significant cause of morbidity and mortality after transplantation. Recently, hepatitis E virus infection has been added as an emergent cause of chronic hepatitis in organ transplantation. The prevalence of HBV and HCV infections has markedly decreased in patients who are candidates for transplantation since the introduction of screening, hygiene and prevention measures, including systematic screening of blood and organ donations, use of erythropoietin, compliance with universal hygiene rules, segregation of HBV-infected patients from non-infected patients and systematic vaccination against HBV. A liver biopsy is preferable to non-invasive biochemical and/or morphological tests of fibrosis to evaluate liver fibrosis before and even after transplantation. Treatment with entecavir or tenofovir is indicated in HBV-infected dialyzed patients who have moderate or severe disease (≥A2 or F2 on the Metavir scale) in preparation for renal transplantation. Due to the risks of severe reactivation, fibrosing cholestatic hepatitis or histological deterioration after transplantation, systematic use of nucleoside or nucleotide analogues shortly before or at the time of transplantation is recommended (tenofovir or entecavir are preferable to lamivudine) in all patients, whatever the baseline histological evaluation. In HCV-infected dialyzed patients who are not candidates for renal transplantation, the indication for antiviral therapy is limited to significant fibrosis (fibrosis ≥2 on the Metavir scale). Treatment must be proposed to all candidates for renal transplantation, whatever their baseline histopathology, and interferon-α should be used as monotherapy. After transplantation, interferon-α is contraindicated but may be used in patients for whom the benefits of antiviral treatment clearly outweigh the risks, especially that of allograft rejection. All cirrhotic patients, notably after solid organ transplantation, should be screened for hepatocellular carcinoma. Sustained suppression of necro-inflammation may result in regression of cirrhosis, which in turn may lead to decreased disease-related morbidity and improved survival. Finally, due to the high mortality after renal transplantation, active (namely without sustained viral suppression) cirrhosis should be considered a contraindication to kidney transplantation, but an indication to combined liver-kidney transplantation; on the contrary, inactive (namely with sustained viral suppression) compensated cirrhosis may permit renal transplantation alone. Organ transplantations other than kidney (cardiac or pulmonary transplantations) involve the same diagnosis and therapeutic issues.

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“…An additional 391 reports were excluded on the basis of title, resulting in 113 eligible trials. Of these, 39 reports were review articles; eight were case reports [19]–[23], [29], [30], [39]; one was an interim report [40]; 12 were conference abstracts [24]–[28], [31], [32], [41]–[45]; 2 included HCV co-infected with HBV [46], [47]; five were combined liver kidney transplantation [48]–[52] and one included patients on maintenance dialysis [53] at the same time, and seven articles contained confounding factors [54]–[60]. After these exclusions, 12 reports met our eligibility criteria and were included in the meta-analysis [61]–[72].…”

Section: Resultsmentioning

confidence: 99%

Interferon-Based Anti-Viral Therapy for Hepatitis C Virus Infection after Renal Transplantation: An Updated Meta-Analysis

Fang

Liu

et al. 2014

PLoS ONE

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BackgroundHepatitis C virus (HCV) infection is highly prevalent in renal transplant (RT) recipients. Currently, interferon-based (IFN-based) antiviral therapies are the standard approach to control HCV infection. In a post-transplantation setting, however, IFN-based therapies appear to have limited efficacy and their use remains controversial. The present study aimed to evaluate the efficacy and safety of IFN-based therapies for HCV infection post RT.MethodsWe searched Pubmed, Embase, Web of Knowledge, and The Cochrane Library (1997–2013) for clinical trials in which transplant patients were given Interferon (IFN), pegylated interferon (PEG), interferon plus ribavirin (IFN–RIB), or pegylated interferon plus ribavirin (PEG–RIB). The Sustained Virological Response (SVR) and/or drop-out rates were the primary outcomes. Summary estimates were calculated using the random-effects model of DerSimonian and Laird, with heterogeneity and sensitivity analysis.ResultsWe identified 12 clinical trials (140 patients in total). The summary estimate for SVR rate, drop-out rate and graft rejection rate was 26.6% (95%CI, 15.0–38.1%), 21.1% (95% CI, 10.9–31.2%) and 4% (95%CI: 0.8%–7.1%), respectively. The overall SVR rate in PEG-based and standard IFN-based therapy was 40.6% (24/59) and 20.9% (17/81), respectively. The most frequent side-effect requiring discontinuation of treatment was graft dysfunction (14 cases, 45.1%). Meta-regression analysis showed the covariates included contribute to the heterogeneity in the SVR logit rate, but not in the drop-out logit rate. The sensitivity analyses by the random model yielded very similar results to the fixed-effects model.ConclusionsIFN-based therapy for HCV infection post RT has poor efficacy and limited safety. PEG-based therapy is a more effective approach for treating HCV infection post-RT than standard IFN-based therapy. Future research is required to develop novel strategies to improve therapeutic efficacy and tolerability, and reduce the liver-related morbidity and mortality in this important patient population.

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Short and long term outcome of kidney transplanted patients with chronic viral hepatitis B and C

Cited by 19 publications

References 42 publications

Meta‐analysis of observational studies: hepatitis C and survival after renal transplant

Meta‐analysis of observational studies: hepatitis C and survival after renal transplant

VIRAL hepatitis in solid organ transplantation other than liver

Interferon-Based Anti-Viral Therapy for Hepatitis C Virus Infection after Renal Transplantation: An Updated Meta-Analysis

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