Gina Choi1, Kristina G Lee, Crystal Wu, Sammy Saab. 1. 1 Department of Medicine, University of California, Los Angeles, CA. 2 Department of Surgery, University of California, Los Angeles, CA.
Abstract
BACKGROUND: There are no standard guidelines for the permissible degree of liver fibrosis in patients with chronic hepatitis C virus prohibiting cadaveric renal transplantation (CRT). METHODS: A decision analysis model was constructed to compare 5-year patient survival using three strategies for patients on hemodialysis. The probabilities of pretransplant and posttransplant survival, progression of liver fibrosis, CRT, and sustained viral response were obtained from a systematic review of the literature. Sensitivity analyses were performed. RESULTS: Kidney transplantation was associated with improved 5-year survival for patients with fibrosis stages 1 to 3, but not stage 4 (cirrhosis). Antiviral therapy was associated with improvement in survival in patients with stage 3 fibrosis. The 5-year survival was similar for patients with stage 4 irrespective of the option of antiviral therapy. The model was sensitive to varying the probability of both pretransplant and posttransplant survival. CONCLUSION: There appears to be no overall 5-year survival benefit in treating S1 and S2 fibrosis patients with hepatitis C virus antiviral therapy before CRT. There is no benefit in overall 5-year survival in patients with cirrhosis and thus should not be candidates for CRT.
BACKGROUND: There are no standard guidelines for the permissible degree of liver fibrosis in patients with chronic hepatitis C virus prohibiting cadaveric renal transplantation (CRT). METHODS: A decision analysis model was constructed to compare 5-year patient survival using three strategies for patients on hemodialysis. The probabilities of pretransplant and posttransplant survival, progression of liver fibrosis, CRT, and sustained viral response were obtained from a systematic review of the literature. Sensitivity analyses were performed. RESULTS: Kidney transplantation was associated with improved 5-year survival for patients with fibrosis stages 1 to 3, but not stage 4 (cirrhosis). Antiviral therapy was associated with improvement in survival in patients with stage 3 fibrosis. The 5-year survival was similar for patients with stage 4 irrespective of the option of antiviral therapy. The model was sensitive to varying the probability of both pretransplant and posttransplant survival. CONCLUSION: There appears to be no overall 5-year survival benefit in treating S1 and S2 fibrosispatients with hepatitis C virus antiviral therapy before CRT. There is no benefit in overall 5-year survival in patients with cirrhosis and thus should not be candidates for CRT.
Authors: Mary G Bowring; Lauren M Kucirka; Allan B Massie; Tanveen Ishaque; Sunjae Bae; Ashton A Shaffer; Jacqueline Garonzik Wang; Mark Sulkowski; Niraj Desai; Dorry L Segev; Christine M Durand Journal: Transplantation Date: 2018-12 Impact factor: 4.939