Published online Feb 18, 2017. doi: 10.4254/wjh.v9.i5.288
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.
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.