Introduction: It has been demonstrated that hepatitis C+ (HCV+) patients with renal failure benefit from kidney transplantation despite having decreased graft survival compared to HCV- patients. It remains unclear however whether renal transplantation impacts hepatic fibrosis in these patients. Long term outcomes and hepatic fibrosis in HCV+ and HCV- patients following renal transplantation.
Methods: Records from HCV+ and HCV- recipients from 2000 to the present were analyzed. Recipient and donor demographics, 1 and 3 year graft outcome, and graft function (serum creatinine and proteinuria) were evaluated. All HCV+ candidates had a liver biopsy by protocol. Statistical evaluation included ANOVA, Log-rank, Cox multivariate and univariate analyses. Liver biopsies were assessed using Metavir scoring.
Results: Since 2000, 195 HCV+ recipients (R+) received renal transplants from HCV+ donors (D+), in contrast to 1418 HCV- recipients (R-) who received grafts from HCV- donors (D-), and 66 R+ patients that received D- kidneys. For R+/D+ transplants, overall 1 and 5 year renal graft survivals were 87% and 62%, respectively. By multivariate analysis, HCV status, delayed graft function, donor age, and HLA disparity contributed to graft loss (p=0.001) in HCV+ recipients. At 3 years, proteinuria was higher in the HCV+ cohort (p=0.05), although serum creatinine was not different. R+/D+ patients experienced hepatic fibrosis progression from a mean of 0.6 to 1.3, over a mean of 4.8 years (p=0.046). In 7 patients with HCV and ESRD, who had not received a transplant, the mean stage of fibrosis increased from 0.8 to 1.9 over 6.8 years (p=0.062). There was no difference in the fibrosis progression rate in HCV+ patients on dialysis when compared to a demographically similar cohort of HCV+ patients (n=20) without renal failure (0.07/yr and 0.07/yr, respectively, p=0.9). In contrast, the fibrosis progression rate was higher in HCV+ patients post-transplant as compared to HCV+ patients on the waiting list (0.53/yr and 0.07/yr, p=0.002).
Kidney transplantation in HCV R+/D+ patients is not associated with worse graft survival, when compared with R-/D- patients. However, hepatic fibrosis may increase at a faster rate in this population. Prospective data is needed to confirm these results.
To cite this abstract in AMA style:Scalea J, Munivenkatappa R, Whitlow V, Neuman B, Fayek S, Cooper M, Philosophe B. Accelerated Hepatic Fibrosis after Renal Transplantation: Long-Term Outcomes in HCV+ Patients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/accelerated-hepatic-fibrosis-after-renal-transplantation-long-term-outcomes-in-hcv-patients/. Accessed October 28, 2020.
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