|
1
|
Aparici CM, Bains SN, Carlson D, Qian J, Liou D, Wojciechowski D, Werner J, Khan S, Kroll C, Sandhu M, Nguyen N, Hawkins R. Recovery of Native Renal Function in Patients with Hepatorenal Syndrome Following Combined Liver and Kidney Transplant with Mercaptoacetyltriglycine-3 Renogram: Developing a Methodology. World J Nucl Med 2016; 15:44-9. [PMID: 26912978 PMCID: PMC4729014 DOI: 10.4103/1450-1147.172140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Many patients with hepatorenal syndrome (HRS) end up receiving a combined liver and kidney transplant (CKLT) with preservation of native kidneys, specially type 1 HRS since is characterizes by a very rapid deterioration of renal function. Eventually, most of the patients regain renal function, but it is unknown if this is due to the transplanted kidney, the recovery of native renal function, or both. The aim of this study is to evaluate if there is recovery of native renal function in patients with HRS following CKLT. 22 patients (16 men; 6 women) with history of HRS and status post CKLT were studied. Mercapto-acetyltriglycine-3 renograms in the anterior and posterior views with the three kidneys in the field of view were simultaneously acquired. The renograms were analyzed by creating regions of interest around the transplanted and native kidneys. Relative contribution to the renal function, clearance, and effective renal plasma flow for the transplanted and native kidneys were obtained. 1/22 (4.5%) patients presented with a very poor functioning transplanted kidney, in 15/22 (68%) cases the combined native renal function was markedly poorer than the transplanted renal function and in 6/22 (27%) native kidneys showed a contribution to the renal function similar to the transplanted kidney. In conclusion, our series show that around 32% of the HRS patients recovered their native renal function after CKLT. Identification of common factors that affect recovery of native renal function may help to avoid unnecessary renal transplants, significantly reducing morbidity and cost, while facilitating a reallocation of scarce donor resources.
Collapse
Affiliation(s)
- Carina Mari Aparici
- Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Department of Radiology, Nuclear Medicine Division, San Francisco VAMC, San Francisco, California, USA
| | - Sukhkarn N Bains
- Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - David Carlson
- Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Jesse Qian
- Department of Medicine, Division of Nephrology, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Douglas Liou
- Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - David Wojciechowski
- Department of Medicine, Division of Nephrology, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Jacob Werner
- Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Sana Khan
- Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Cameron Kroll
- Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Manreet Sandhu
- Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Nhan Nguyen
- Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Randall Hawkins
- Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| |
Collapse
|
|
2
|
Perumpail RB, Wong RJ, Scandling JD, Ha LD, Todo T, Bonham CA, Saab S, Younossi ZM, Ahmed A. HCV infection is associated with lower survival in simultaneous liver kidney transplant recipients in the United States. Clin Transplant 2015. [PMID: 26205329 DOI: 10.1111/ctr.12598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The frequency of simultaneous liver kidney transplantation (SLKT) has been increasing over the past decade. Hepatitis C virus (HCV) infection is the most common indication for liver transplantation in the United States. Given the rising prevalence of HCV-related SLKT, it is important to understand the impact of HCV in this patient population. METHODS We conducted a retrospective cohort study using data from the United Network for Organ Sharing registry to assess adult patients undergoing SLKT in the United States from 2003 to 2012. Patient survival following SLKT was assessed using Kaplan-Meier methods and multivariate Cox proportional hazards models. RESULTS Patients infected with non-HCV have significantly lower survival following SLKT compared to non-HCV patients at three (three-yr survival: 71.0% vs. 78.9%, p < 0.01) and five yr (five-yr survival: 61.4% vs. 72.5%, p < 0.01). The results of multivariate regression analyses demonstrated that patients infected with HCV had significantly lower survival following SLKT than patients with non-HCV disease (HR 1.41, 95% CI, 1.19-1.67, p < 0.001). In addition, lower post-SLKT survival was noted among patients with diabetes (HR 1.34, 95% CI, 1.13-1.58, p < 0.001) and hepatocellular carcinoma (HR 1.60, 95% CI, 1.17-2.18, p < 0.01). CONCLUSIONS Hepatitis C infection is associated with lower patient survival following SLKT.
Collapse
Affiliation(s)
- Ryan B Perumpail
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital Campus, Oakland, CA, USA
| | - John D Scandling
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA, USA
| | - Le Dung Ha
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Tsuyoshi Todo
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Clark A Bonham
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Sammy Saab
- Departments of Medicine and Surgery, UCLA, Los Angeles, CA, USA
| | - Zobair M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
|
3
|
Hibi T, Nishida S, Sageshima J, Levi DM, Ruiz P, Roth D, Martin P, Okabayashi K, Burke GW, Ciancio G, Tzakis AG. Excessive immunosuppression as a potential cause of poor survival in simultaneous liver/kidney transplantation for hepatitis C. Transpl Int 2014; 27:606-16. [PMID: 24606223 DOI: 10.1111/tri.12303] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/26/2013] [Accepted: 03/03/2014] [Indexed: 02/06/2023]
Abstract
Appropriate recipient selection of simultaneous liver/kidney transplantation (SLKT) remains controversial. In particular, data on liver graft survival in hepatitis C virus-infected (HCV+) SLKT recipients are lacking. We conducted a single-center, retrospective study of HCV+ SLKT recipients (N = 25) in comparison with HCV- SLKT (N = 26) and HCV+ liver transplantation alone (LTA, N = 296). Despite backgrounds of HCV+ and HCV- SLKT being similar, HCV+ SLKT demonstrated significantly impaired 5-year liver graft survival of 35% (HCV- SLKT, 79%, P = 0.004). Compared with HCV+ LTA, induction immunosuppression was more frequently used in HCV+ SLKT. Five-year liver graft survival rate for HCV+ SLKT was significantly lower than that for LTA (35% vs. 74%, respectively, P < 0.001). Adjusted hazard ratio of liver graft loss in HCV+ SLKT was 4.9 (95% confidence interval 2.0-12.1, P = 0.001). HCV+ SLKT recipients were more likely to succumb to recurrent HCV and sepsis compared with LTA (32% vs. 8.8%, P < 0.001 and 24% vs. 8.8%, P = 0.030, respectively). Ten HCV+ SLKT recipients underwent anti-HCV therapy for recurrent HCV; only 1 achieved sustained virological response. HCV+ SLKT is associated with significantly decreased long-term prognosis compared with HCV- SLKT and HCV+ LTA.
Collapse
Affiliation(s)
- Taizo Hibi
- Miami Transplant Institute, University of Miami Leonard M. Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA; DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA; Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
4
|
Latt NL, Alachkar N, Alachka N, Taydas E, Cameron A, Gurakar A. Diagnosing hepatitis C virus and improved outcomes in overall and kidney graft survival among simultaneous liver-kidney transplant recipients in the post-MELD era. EXP CLIN TRANSPLANT 2014; 12 Suppl 1:45-9. [PMID: 24635792 DOI: 10.6002/ect.25liver.l48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We compared survival outcomes among simultaneous liver-kidney transplants after model for end-stage liver disease (MELD) according to their specific diagnosis and hepatitis C virus versus nonhepatitis C virus. MATERIALS AND METHODS Clinical data review was performed for all patients who underwent combined liver-kidney transplants at Johns Hopkins Hospital from January 31, 1995, to October 31, 2012. Differences in demographics and characteristics among 2 groups were compared using independent samples t test. Survival analysis and distributions were calculated using Kaplan-Meier and Mantel-Cox log-rank test. RESULTS Of 48 combined liver-kidney transplants, 31 simultaneous liver-kidney transplants cases were included; nonsimultaneous liver-kidney transplants and patients with prior transplants were excluded. Proportions of age, sex, ethnicity, pre-MELD score, pretransplant renal replacement therapy requirement, hypertension, diabetes mellitus, and follow-up were similar in both groups. Median follow-up was 30 months. Overall and graft survival rates among simultaneous liver-kidney transplants recipients in the pre-MELD era were significantly superior to simultaneous liver-kidney transplants patients in the post-MELD era (P = .0473). However, overall and graft survival rates among simultaneous liver-kidney transplants recipients who had hepatitis C virus and non-hepatitis C virus causes were not statistically different. CONCLUSIONS We demonstrated a statistically significant difference in overall and kidney graft survival between the post-MELD era and the pre-MELD era. Subgroup analyses of this group showed no statistically significant difference in overall and kidney-graft survival when compared with their specific diagnosis of hepatitis C virus. This must be further studied and verified in a larger cohort of patients to fully identify the effect of hepatitis C virus infection in this group of patients because it can affect both liver and kidney grafts after transplant.
Collapse
Affiliation(s)
- Nyan L Latt
- Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | | | | | | | | | | |
Collapse
|
|
5
|
Congly SE, Doucette KE, Coffin CS. Outcomes and management of viral hepatitis and human immunodeficiency virus co-infection in liver transplantation. World J Gastroenterol 2014; 20:414-424. [PMID: 24574710 PMCID: PMC3923016 DOI: 10.3748/wjg.v20.i2.414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/22/2013] [Accepted: 11/05/2013] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation for human immunodeficiency virus (HIV) positive patients with viral hepatitis co-infection is increasingly offered in many North American and European liver transplant centers. Prior studies have demonstrated acceptable post-transplant outcomes and no increased risk of HIV complications in patients co-infected with hepatitis B virus (HBV). However, liver transplantation in HIV positive patients with hepatitis C virus (HCV) has poorer outcomes overall, requiring careful selection of candidates. This review aims to summarize the published literature on outcomes after transplant in HIV patients with HBV or HCV related end-stage liver disease and recommendations for management. In particular the pre-transplant factors impacting outcomes in HCV/HIV co-infected candidates and importance of multidisciplinary management will be discussed.
Collapse
|
|
6
|
Sourianarayanane A, Raina R, Garg G, McCullough AJ, O'Shea RS. Management and outcome in hepatorenal syndrome: need for renal replacement therapy in non-transplanted patients. Int Urol Nephrol 2013; 46:793-800. [PMID: 23934619 DOI: 10.1007/s11255-013-0527-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 07/23/2013] [Indexed: 01/10/2023]
Abstract
PURPOSE Hepatorenal syndrome (HRS) type I is a devastating complication of decompensated cirrhosis. Liver transplantation (LT) offers an excellent survival, and renal replacement therapy (RRT) may be useful until transplantation is available. The survival benefit of RRT in the absence of LT is thought to be short and its benefit in these patients is unknown. To investigate this, we studied the outcome of different therapies (pharmacological, RRT, and LT) in patients with type 1 HRS. METHODS Medical records (2005-2009) of all cirrhotic patients admitted to our facility with abnormal renal function were reviewed. Patients with preexisting renal disease, diagnosis other than type I HRS, or those without long-term follow-up were excluded. RESULTS Of 380 patients reviewed, 30 were studied. Nineteen (63.3 %) patients underwent liver transplantation. No difference in baseline liver or renal parameters was noted between those who were or were not transplanted. A decreased mortality was noted (5.3 vs. 64.6 %; p = 0.0005) compared to patients who were not transplanted during the study follow-up median period of 7.8 [CI 1.9-34] months. Among non-transplanted patients, no differences in median survival (8.8 vs. 6.5 months; p = 0.62) or in other parameters studied were found in those patients who received RRT compared to those who did not. Similarly, no survival difference was found comparing those who did or did not receive pharmacological therapy without transplant. CONCLUSION In type I HRS, LT offers better survival. Among patients who do not receive LT, RRT does not provide an improved survival benefit.
Collapse
|
|
7
|
Hibi T, Sageshima J, Molina E, Ciancio G, Nishida S, Chen L, Arosemena L, Mattiazzi A, Guerra G, Kupin W, Tekin A, Selvaggi G, Levi D, Ruiz P, Livingstone AS, Roth D, Martin P, Tzakis A, Burke GW. Predisposing factors of diminished survival in simultaneous liver/kidney transplantation. Am J Transplant 2012; 12:2966-73. [PMID: 22681708 DOI: 10.1111/j.1600-6143.2012.04121.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Since the adoption of the Model for End-Stage Liver Disease, simultaneous liver/kidney transplants (SLKT) have substantially increased. Recently, unfavorable outcomes have been reported yet contributing factors remain unclear. We retrospectively reviewed 74 consecutive adult SLKT performed at our center from 2000 to 2010 and compared with kidney transplant alone (KTA, N = 544). In SLKT, patient and death-censored kidney graft survival rates were 64 ± 6% and 81 ± 5% at 5 years, respectively (median follow-up, 47 months). Multivariable analyses revealed three independent risk factors affecting patient survival: hepatitis C virus positive (HCV+, hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.1-7.9), panel reactive antibody (PRA) > 20% (HR 2.8, 95% CI 1.1-7.2) and female donor gender (HR 2.9, 95% CI 1.1-7.9). For death-censored kidney graft survival, delayed graft function was the strongest negative predictor (HR 8.3, 95% CI 2.5-27.9), followed by HCV+ and PRA > 20%. The adjusted risk of death-censored kidney graft loss in HCV+ SLKT patients was 5.8 (95% CI 1.6-21.6) compared with HCV+ KTA (p = 0.008). Recurrent HCV within 1 year after SLKT correlated with early kidney graft failure (p = 0.004). Careful donor/recipient selection and innovative approaches for HCV+ SLKT patients are critical to further improve long-term outcomes.
Collapse
Affiliation(s)
- T Hibi
- Miami Transplant Institute, University of Miami and Jackson Memorial Hospital, Miami, FL, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
8
|
Carbone M, Cockwell P, Neuberger J. Hepatitis C and kidney transplantation. Int J Nephrol 2011; 2011:593291. [PMID: 21755059 PMCID: PMC3132687 DOI: 10.4061/2011/593291] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/05/2011] [Accepted: 04/13/2011] [Indexed: 12/17/2022] Open
Abstract
Hepatitis C virus (HCV) infection is relatively common among patients with end-stage kidney disease (ESKD) on dialysis and kidney transplant recipients. HCV infection in hemodialysis patients is associated with an increased mortality due to liver cirrhosis and hepatocellular carcinoma. The severity of hepatitis C-related liver disease in kidney transplant candidates may predict patient and graft survival after transplant. Liver biopsy remains the gold standard in the assessment of liver fibrosis in this setting. Kidney transplantation, not haemodialysis, seems to be the best treatment for HCV+ve patients with ESKD. Transplantation of kidneys from HCV+ve donors restricted to HCV+ve recipients is safe and associated with a reduction in the waiting time. Simultaneous kidney/liver transplantation (SKL) should be considered for kidney transplant candidates with HCV-related decompensated cirrhosis. Treatment of HCV is more complex in hemodialysis patients, whereas treatment of HCV recurrence in SLK recipients appears effective and safe.
Collapse
Affiliation(s)
- Marco Carbone
- Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
| | - Paul Cockwell
- Department of Nephrology, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
| | - James Neuberger
- Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
| |
Collapse
|
|
9
|
|
|
10
|
|