One-year outcomes in patients with advanced liver fibrosis or compensated cirrhosis from chronic hepatitis C receiving kidney transplant alone.
Brown P, Kumssa F, and Venkat D. One-year outcomes in patients with advanced liver fibrosis or compensated cirrhosis from chronic hepatitis C receiving kidney transplant alone. Am J Transplant 2018; 18:942.
Am J Transplant
Background: Hepatitis C (HCV) was difficult to treat post-kidney transplant prior to the direct acting antiviral (DAA) era. As such patients with advanced fibrosis and compensated cirrhosis due to HCV were considered ineligible to receive kidney transplant alone (KTA). We assessed the safety of KTA at our center in the DAA era in patients with advanced liver fibrosis (Metavir 3) or compensated cirrhosis due to chronic HCV. Methods: KTA patients transplanted in the DAA era (2014-present) with HCV viremia at transplant were reviewed. Baseline data included age, gender, race, BMI, liver fibrosis as assessed by fibroscan or biopsy, kidney donor HCV status, HCV genotype and prior HCV treatment. Compensated cirrhosis was defi ned as cirrhosis on biopsy but lack of portal hypertension (pHTN) by hepatic venous pressure gradient measurement. Outcome data included survival, liver and renal function one-year post transplant. Results: 24 viremic patients underwent KTA of whom 5 patients had compensated cirrhosis and 1 had advanced fibrosis at time of transplant. HCV genotypes were 1a (17) or 1b HCV (7). All 24 received HCV positive deceased donor kidneys and were treated with prednisone, tacrolimus and mycophenolate mofetil per standard protocol. Survival was 100% at 1 year (24/24). 1 year post transplant mean creatinine was 1.2 mg/dL in the advanced fibrosis/cirrhosis group and 1.7 mg/dL in the non-advanced fi brosis group. 19/24 patients successfully underwent DAA treatment post-transplant including all in the advanced fibrosis/cirrhosis group, the majority within 1 year. The remaining 5 have yet to be treated. None of the patients had hepatic decompensation defi ned by new onset ascites, pHTN-mediated bleeding or encephalopathy. There was no significant change in mean serum bilirubin at 1 year from baseline in either group. Discussion: In the short term renal transplant alone with HCV positive donor kidneys is safe with early DAA therapy post-transplant in HCV viremic patients with advanced liver fibrosis and compensated cirrhosis. There was no detrimental effect on survival, renal or liver function within 1 year of transplant. HCV can be treated early after kidney transplant preventing hepatic decompensation. Further follow-up is needed to assess long term outcomes.