Tulane Transplant Institute, Tulane University School of Medicine, New Orleans, LA, USA.
Transplantation. 2012 Aug 15;94(3):250-4. doi: 10.1097/TP.0b013e318255f890.
Kidney transplantation (KTx) alone in patients with cirrhosis and renal failure (end-stage renal disease [ESRD]) infected with hepatitis C virus (HCV) is controversial. The aim of this study was to compare outcomes of HCV+ patients with ESRD and cirrhosis (C group) versus HCV+ patients with ESRD but with no cirrhosis (NC group) listed for KTx.
Ninety HCV+ patients with ESRD were evaluated for KTx between 2003 and 2010. Listed patients underwent transjugular liver biopsy with hepatic portal venous gradient (HPVG) measurements. Only patients with HPVG less than 10 mm Hg were considered for KTx alone. We analyzed patient demographics, waitlist/liver disease characteristics, and posttransplant outcomes between groups.
Sixty-four patients listed for KTx alone were studied. Twelve patients (18.75%) showed biopsy-proven cirrhosis. Thirty-seven patients underwent KTx alone (9 from C and 28 from NC). No patients developed decompensation of their liver disease, although one patient for NC group developed metastatic hepatocellular carcinoma 16 months after transplantation. One- and three-year graft survival rates were 75% and 75% versus 92.1% and 75.1% for groups C and NC, respectively (P=0.72). One- and three-year patient survival rates were 88.9% and 88.9% versus 96.3% and 77.9% for groups C and NC, respectively (P=0.76). Only increasing recipient age and decreasing albumin levels were significantly associated with worse graft and patient survival.
Our study suggests that KTx alone may be safe in patients with compensated HCV, cirrhosis, and ESRD with HPVG less than 10 mm Hg. A simultaneous liver-kidney transplantation may be an unnecessary use of a liver allograft in these patients.
单独进行肾移植（KTx）治疗伴有丙型肝炎病毒（HCV）感染的肝硬化和肾衰竭（终末期肾病 [ESRD]）患者存在争议。本研究旨在比较伴有 ESRD 和肝硬化（C 组）与伴有 ESRD 但无肝硬化（NC 组）的 HCV+患者的 KTx 结果。
评估了 2003 年至 2010 年间 90 名 HCV+伴有 ESRD 的患者进行 KTx 的情况。列出的患者接受经颈静脉肝活检和肝门静脉梯度（HPVG）测量。仅对 HPVG 小于 10mmHg 的患者考虑单独进行 KTx。我们分析了患者的人口统计学、等待名单/肝脏疾病特征和移植后结果。
研究了 64 名单独进行 KTx 的患者。12 名患者（18.75%）经肝活检证实为肝硬化。37 名患者接受了单独的 KTx（9 名来自 C 组，28 名来自 NC 组）。没有患者出现肝脏疾病失代偿，尽管 NC 组的一名患者在移植后 16 个月发生转移性肝细胞癌。C 组和 NC 组的 1 年和 3 年移植物存活率分别为 75%和 75%、92.1%和 75.1%（P=0.72）。C 组和 NC 组的 1 年和 3 年患者存活率分别为 88.9%和 88.9%、96.3%和 77.9%（P=0.76）。只有受体年龄增加和白蛋白水平降低与移植物和患者存活率降低显著相关。
我们的研究表明，对于伴有代偿性 HCV、肝硬化和 HPVG 小于 10mmHg 的 ESRD 患者，单独进行 KTx 可能是安全的。在这些患者中，同时进行肝-肾移植可能是对肝脏供体的不必要利用。
