Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 18, 2017; 9(5): 288-292
Published online Feb 18, 2017. doi: 10.4254/wjh.v9.i5.288
Is it time to rethink combined liver-kidney transplant in hepatitis C patients with advanced fibrosis?
Niraj James Shah, Mark W Russo
Niraj James Shah, Department of Medicine, Division of Digestive Diseases, the University of Mississippi Medical Center, Jackson, MS 39216, United States
Mark W Russo, Transplant Center-Carolinas Medical Center, 6th Floor Morehead Medical Plaza, Charlotte, NC 28024, United States
Author contributions: Both the authors contributed to the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Niraj James Shah, MD, Assistant Professor of Medicine, Department of Medicine, Division of Digestive Diseases, the University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, United States.
Telephone: +1-601-9844540 Fax: +1-601-9844548
Received: September 27, 2016
Peer-review started: September 28, 2016
First decision: October 31, 2016
Revised: December 4, 2016
Accepted: December 16, 2016
Article in press: December 19, 2016
Published online: February 18, 2017

To reduce hepatic and extrahepatic complications of chronic hepatitis C in kidney transplant recipients.


We conducted a systematic review of kidney only transplant in patients with hepatitis C and advanced fibrosis.


The 5 year patient survival of kidney transplant recipients with and without hepatitis C cirrhosis ranged from 31% to 90% and 85% to 92%, respectively. Hepatitis C kidney transplant recipients had lower 10-year survival when compared to hepatitis B patients, 40% and 90% respectively. There were no studies that included patients with virologic cure prior to kidney transplant that reported post-kidney transplant outcomes. There were no studies of direct acting antiviral therapy and effect on patient or graft survival after kidney transplantation.


Data on kidney transplant only in hepatitis C patients that reported inferior outcomes were prior to the development of potent direct acting antiviral. With the development of potent directing acting antiviral therapy for hepatitis C with high cure rates studies are needed to determine if patients with hepatitis C, including those with advanced fibrosis, can undergo kidney transplant alone with acceptable long term outcomes.

Keywords: Cirrhosis/cirrhotics, Renal transplantation, Kidney transplantation, Mortality, Systematic review, Graft outcomes, Meta-analysis

Core tip: Individuals with chronic hepatitis C with advanced fibrosis and kidney failure who undergo kidney transplant alone are believed to have lower long-term survival. Surprisingly, we have only a few studies with inconsistent results. The concern about isolated-kidney-transplant alone is that the liver disease would progress to decompensated cirrhosis and liver failure in the setting of immunosuppression after kidney transplant. Earlier, interferon was associated with low virologic cure and high adverse events including graft rejection. However, with development of newer directly acting anti-virals we wish to invite our readers to reconsider the need for a combined liver-kidney transplant in hepatitis C patients with advanced fibrosis or compensated cirrhosis.