Kidney Transplantation Alone in ESRD Patients With Hepatitis C Cirrhosis

Abstract

We read with great interest the article titled “Kidney Transplantation Alone in ESRD Patients with Hepatitis C Cirrhosis” (1). We have recently reviewed our own experience with KTA in well-compensated cirrhotics (submitted for publication). We agree that the presence of cirrhosis in HCV-positive patients is not a significant variable affecting either graft or patient survival. In our study, we compared 18 well-compensated cirrhotics versus 103 HCV-positive noncirrhotics. Our 1- and 3-year death-censored graft survival was 89 and 78% for the cirrhotics and 95% and 81% for NC. Our patient survival at 1 and 3 years were 100% and 83% for the cirrhotic group and 91% and 83% for NC. In our study, recipient age was not a factor in any outcomes. Serum albumin and platelet count were not a factor in allograft outcomes in the cirrhotic group. Additionally, both groups did not show any statistically significant differences in multiple demographic variables, patient survival, graft survival, adherence, acute rejection at 1 year, delayed graft function and liver decompensation or infection as a cause of graft loss or death. In our study, cancer was statistically more significant in the cirrhotic group. We attributed this to the use of thymoglobulin induction (immunosuppression was not addressed by Paramesh et al.). Additionally, many of the patients who developed cancer were retransplant recipients and KTA after liver transplantation. We agree that it is imperative to maximize the use of HCV-positive donor organs. In our study, more than two thirds of the recipients received HCV+ grafts without negatively affecting patient or allograft survival. We do not limit the use of HCV+ donors to genotype 1 patients. We also do not combine ECD with HCV. None of our cirrhotic patients received ECD kidneys. Although there was no association between donor ECD versus SCD in recipient outcomes in the paper by Paramesh et al., we believe that the HR of 2.78 for graft survival is important and may become relevant with a larger cohort studied over a longer period. In summary, in our report of 121 transplants, we confirm that well-compensated cirrhosis is not a negative prognostic indicator. Additionally, we very closely studied multiple donor and recipient variables and outcomes. We found a higher incidence of cancer in our cirrhotic group, perhaps attributed to aggressive induction. We are hopeful that this may lead to timely KTA and will minimize liver allograft wastage. Stalin Campos Afshin Parsikia Radi F. Zaki Jorge A. Ortiz Department of Transplant Albert Einstein Medical Center Philadelphia, PA