Graft Outcomes in Kidney Transplantation Alone with Concomitant Cirrhosis

Abstract

aim: The influence of cirrhosis on kidney graft survival post-transplantation has not been well defined. As previously demonstrated, lower rates of patient overall survival (31%) were in conjunction with lower rates of 5-year graft survival (31%) in cirrhotic patients who received a kidney transplant alone. Unfortunately, there is scarce data on the graft survival in patients who receive a kidney transplant alone with concomitant cirrhosis. Methods: Among 131 patients with kidney transplantations at Methodist Specialty Hospital in San Antonio, TX between January 1999 and December 2011 with serological evidence of hepatitis B or C, 12 patients were found to have concomitant cirrhosis at time of transplantation. Rates of survival at 3-years were compared to the national average and overall for Methodist Specialty Hospital. Results: In the 12 patients, cirrhosis etiologies included hepatitis B (n=2), hepatitis C (n=7) and cryptogenic (n=3). All were confirmed by histology at or within 6 months prior to kidney transplantation. The median graft survival was 8.1 years and graft survival at 3- and 5-years were 75% and 58%, respectively. Conclusion: Preliminary data suggests that cirrhotic patients might be considered for combined liver and kidney transplantation. Graft survival at 3 years is far below the national average (85%) and Methodist Hospital overall (89%). Study also demonstrates the benefit of a liver biopsy with or without portal pressure measurement prior to transplantation in patients with viral hepatitis and/or other hepatic disease to accurately stage fibrosis.