Diagnosing hepatitis C virus and improved outcomes in overall and kidney graft survival among simultaneous liver-kidney transplant recipients in the post-MELD era.

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.