Outcomes of patients with hepatitis C undergoing simultaneous liver–kidney transplantation☆

Background/Aims

The number of simultaneous liver–kidney transplants (SLK) has increased since the MELD era. Data on short- and long-term outcomes of hepatitis C virus positive (HCV+) SLK compared to HCV+ liver transplant alone (LTA) recipients are limited.

Methods

A case-control study comparing outcomes of HCV+SLK versus transplant year-matched HCV+ LTA (1:1) was performed.

Results

38/142 (26.7%) SLK recipients were HCV+. LTA controls had lower MELD (17.4±8.6) at transplant than SLK (34.5±6.6) (p=0.001). There were increased early post-transplant infection episodes in SLK (56.3%) versus LTA (21.6%) (p=0.001) and a trend towards increased early mortality in the SLK group (p=0.08). However, there was no difference in long-term patient and graft survival, time to HCV recurrence, %⩾ stage 2 fibrosis, renal function, and graft function between the groups. Ten SLK recipients were treated for HCV recurrence with pegylated interferon+ribavirin: two had sustained virologic response, five stopped due to side effects, and three had no response. None had liver or kidney rejection on treatment.

Conclusion

Our data represent the largest analysis of HCV+ SLK outcomes to date. We demonstrate increased early complications in SLK versus LTA recipients, likely due to being more critically ill at transplant (higher MELD) and complications unrelated to HCV within the first year. However, long-term outcomes, i.e. HCV recurrence, graft/renal dysfunction, are similar to LTA. In addition, while data are limited, treatment of HCV recurrence with interferon appeared safe in our SLK recipients.

Abbreviations: SLK, simultaneous liver–kidney transplant, MELD, model for end-stage liver disease, HCV+, hepatitis C virus positive, LTA, liver transplant alone, IFN, interferon, RBV, ribavirin, RRT, renal replacement therapy, SVR, sustained viral response, ICU, intensive care unit, ECD, expanded criteria donor, ALT, alanine aminotransferase

Keywords: Hepatitis C virus, Liver transplantation, Kidney transplantation, Simultaneous liver–kidney transplantation, Interferon, Recurrent disease