Editorial: when cirrhosis deserves haemodialysis-rethinking strategies. Authors'' reply - Université de Lille Accéder directement au contenu
Article Dans Une Revue Alimentary Pharmacology and Therapeutics Année : 2019

Editorial: when cirrhosis deserves haemodialysis-rethinking strategies. Authors'' reply

Résumé

We read with interest the comments of Dr Reverter on our article entitled “The prognostic impact of cirrhosis in patients receiving maintenance haemodialysis”.1, 2 We agree that the decision to initiate haemodialysis in patients with decompensated cirrhosis should be weighted according to anticipation of their low survival and therefore mainly reserved for those with a possibility of improvement of liver function or to candidates for simultaneous liver-kidney transplantation (SLKT). We also agree with Dr Reverter that our results raise the question of the best strategy for haemodialysis patients with compensated cirrhosis because maintenance on haemodialysis and isolated kidney transplantation are both problematical. Using our predictive model based on Child-Pugh, a haemodialysis patients with compensated cirrhosis considered as an optimal candidate to kidney transplantation (40-year-old, no history of cancer) would have 5-year survival on haemodialysis of only 55% (personal data). We observed, in a recent study of HCV kidney transplant recipients, that kidney transplantation alone in patients with compensated cirrhosis is problematic when considering their 5- and 10-year survival at 71% (personal data) and 16.4%.3 This latter result may be explained by the fact that the risk of hepatocellular carcinoma and liver decompensation remains significant and could even be increased by immunosuppressive regimen.4-8 Thus, strict screening of hepatocellular carcinoma and evaluation of liver function are crucial in kidney recipients with compensated cirrhosis.5 Conversely, 5-year survival of patients who underwent SLKT is around 70%–75%.9, 10 We agree that specific survival data of haemodialysis patients with compensated cirrhosis classified as stage 1 (absence of portal hypertension) are still lacking in previous studies including our two recent.2, 3 Despite the absence of such data, we consider that haemodialysis patients with compensated cirrhosis should be evaluated for SLKT. Such proposition calls into question the KDIGO guidelines recommending isolated kidney transplantation in HCV-infected patients with compensated cirrhosis in the absence of portal hypertension.11 The future writing of expert guidelines for kidney transplantation in patients with compensated cirrhosis should take into account the precautionary principle after analysis of available studies.

Dates et versions

hal-04564241 , version 1 (30-04-2024)

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Citer

Florent Artru, Alexandre Louvet, Marc Hazzan, Philippe Mathurin. Editorial: when cirrhosis deserves haemodialysis-rethinking strategies. Authors'' reply. Alimentary Pharmacology and Therapeutics, 2019, Alimentary Pharmacology and Therapeutics, 50, pp.457-458. ⟨10.1111/apt.15366⟩. ⟨hal-04564241⟩

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