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Considerations for Exclusion of Hepatitis C+ Recipients in Kidney Transplantation

This article discusses the implications of Hepatitis C positivity in potential kidney transplant recipients. It highlights decreased long-term patient survival, compromised graft function, and increased risks of chronic liver and renal diseases. The paper elaborates on various risk factors affecting post-transplant outcomes for HCV+ patients, including the role of immunosuppressive treatments and HCV RNA levels. Additionally, it examines the impact of Hepatitis C on immunological function, diabetes, and opportunistic infections in co-infected patients, raising questions regarding their inclusion in transplantation protocols.

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Considerations for Exclusion of Hepatitis C+ Recipients in Kidney Transplantation

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  1. Hepatitis C+ Recipients: Considerations for Exclusion Emily A. Blumberg, M.D.

  2. Hepatitis C+ Recipients and Transplantation • Decreased long term patient survival • Decreased long term graft function • Increased risk of chronic liver disease • Increased risk of renal disease • Impaired immunological function • Increased risk of post transplant diabetes mellitus

  3. Kidney Transplant Survival Based on HCV Status Legendre, et al. Transplantation 1998

  4. Graft Survival in Kidney Transplant Recipients Mathurin, et al. Hepatology 1999

  5. Outcome of HCV+ Recipients After OLT • Median time to cirrhosis 12 years • 28% cirrhotic at 5 years • Decompensation < 1 year, typically with ascites • Decompensation associated with >50% 1 year mortality • Risk factors for fibrosis post transplant • HCV RNA level at OLT • Immunosuppressive regimen (MMF, Rejection Rx) • Year of transplantation

  6. Impact of HCV on Liver Disease in Kidney Transplantation Hanafusa, et al, Transplantation 1998

  7. Interferon Treatment of HCV Post Transplant • Poorly tolerated • Limited efficacy • Potential increased risk of rejection • Potential risk of renal failure

  8. Post Transplant Nephropathy and HCV+ Recipients • HCV is a risk factor for de novo immune mediated post transplant nephropathy • Membranoproliferative GN • Membranous GN • Changes may be seen in first 4 months • Patients with autoimmune renal disease may have decreased progression of hepatic disease

  9. Probability of Death Due to Sepsis in Renal Transplant Patients Pereira, et al. Transplantation 1995

  10. In vitro Proliferative Responses in Renal Transplant Patients Khanna, et al. Transplant 2001, abstr542

  11. Impact of HCV on Post Transplant Diabetes Mellitus Baid, et al Transplant 2001 abstract 86

  12. Impact of HCV on HIV Infection • Increased mortality • Increased risk of opportunistic infection • Impaired/delayed CD4 recovery

  13. HCV + Recipients • Inclusion of HCV coinfected pts for OLT if we want to minimize harm and improve outcome? • Does the high rate of HCV infection justify inclusion? • Will liver bx pre kidney tx be adequate to protect subjects from liver disease? • Should HCV treatment decisions be left to pt and PCP?

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