Indication for Liver Transplantation After Direct-Acting Agents in the Treatment of Patients With Hepatitis C.

BACKGROUND: The development of new direct-acting antivirals (DAA) for hepatitis C virus (HCV) treatment has reduced the indications for liver transplantation (LT). We analyzed the indications, characteristics, and evolution of patients with HCV infection who were treated with DAA-based therapies and who underwent LT. MATERIAL AND METHODS: A retrospective single-center study was performed. Data were collected of patients undergoing LT owing to HCV infection between January 2016 and August 2020. Overall characteristics of the patients were analyzed and divided into 2 groups according to the indication for LT: hepatocellular carcinoma (HCC) or decompensated cirrhosis (DC). Differences between biliary and vascular complications after surgery and survival time were compared. RESULTS: Of 156 LTs, 33 (22%) were performed in patients with HCV infection in this period, which shows a decrease of nearly 16% when comparing this period with the interferon/ribavirin era. Indications for LT were 56.7% in patients with HCC and 43.3% in patients with DC. After DAA treatment, all patients developed a sustained viral response. Mean age of the global series, HCC group, and DC group were 56.9, 58.71, and 54.4 years, respectively (P = .041); 53.8% of the HCV-DC group initiated DAA treatment by the time to be included at the waiting list, compared with 17.6% of HCV-HCC group (P = .045). There were no statistically significant differences in terms of survival or biliary and vascular complications after LT. CONCLUSION: Patients with HCV are still part of the waiting list, mainly because of HCC. No statistical differences were shown in terms of postoperative complications or survival. Studies with a higher number of patients are needed.

Renal Function in Receptors With Simultaneous Liver-Kidney Transplant From the Same Donor.

Controversy surrounds the suitability of simultaneous liver-kidney transplant (SLKT) when compared with sequential transplant. Pretransplant renal failure is a post-transplant mortality predictor, and studies demonstrate worse functioning and lower survival of the renal graft when compared with kidney transplant alone (KTA). BACKGROUND: This study compares renal function in patients with SLKT and those who received the contralateral kidney from the same donor. MATERIAL AND METHODS: From June 2017 to February 2021, 5 SLKTs were performed in our hospital, and contralateral kidney grafts took place in other Andalusian Modification on Diet in Renal Disease-4 hospitals. Renal function was assessed according to glomerular filtration (GF) by the formula (that uses 4 variables: creatinine, age, sex, and race) during different periods of time; and the average increase of GF during 6 months in both groups was compared. Other factors from donors and receptors were also compared. RESULTS: No statistically significant differences between average GF in both groups were found; however, there were statistically significant differences when we compared the GF increase 6 months after the transplant in both groups of patients, being that increase higher in patients with KTA. CONCLUSIONS: Despite our small sample size, our study found that patients with SLKT have worse functioning of the kidney graft than those with KTA.