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Published on: June 26, 2020
[Hepatitis C virus and renal transplantation]
Insights
Hepatitis C virus (HCV) significantly increases mortality risk in kidney transplant recipients. However, using HCV-positive donor kidneys for HCV-infected patients may be a viable option, pending further research.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Immunology
Context:
- Liver disease is a significant complication post-renal transplantation (RT).
- Hepatitis C virus (HCV) is the primary driver of liver disease in RT recipients.
- The impact of HCV on patient and graft survival is a critical concern.
Purpose:
- To evaluate the impact of HCV infection on mortality and graft survival after RT.
- To assess the risk associated with using HCV-positive donor kidneys in RT.
- To explore the potential of utilizing HCV-positive donor organs for HCV-infected recipients.
Summary:
- Retrospective studies indicate higher mortality in HCV-positive RT recipients compared to HCV-negative recipients.
- Analysis of large databases (USRDS) reveals an independent increased mortality risk (HR 2.12) for recipients of HCV-positive donor kidneys.
- HCV clearance and long-term outcomes after RT are being investigated, with some patients showing sustained virological response to antiviral therapy.
Impact:
- Findings highlight the increased mortality associated with HCV in RT recipients.
- Suggests a potential strategy of using HCV-positive donor kidneys for HCV-infected recipients, requiring informed consent.
- Emphasizes the need for prospective studies to better understand HCV infection dynamics and long-term outcomes in renal allograft recipients.
Abstract:
Liver disease has emerged as an important cause of morbidity and mortality after renal transplantation (RT). Hepatitis C virus (HCV) is the leading cause of liver disease after RT. The impact of HCV infection on patient and graft survival is currently a major concern. Retrospective studies with appropriate follow-up have mainly demonstrated that HCV positive patients have greater mortality compared to HCV negative recipients after RT. Novel investigations by large databases (United States Renal Data Systems (USRDS)) have shown that recipients of donor HCV-positive kidneys are at an independently increased risk of mortality, adjusted hazard ratio 2.12 (95% confidence interval (95% CI), 1.72-2.87, p<0.001); there was no evidence that any subgroup was less affected. With appropriate informed consent, the use of a renal graft from an HCV positive donor could be offered to an HCV infected recipient. Many renal transplant candidates have satisfactory virological responses to antiviral therapy; the persistence of HCV clearance over a prolonged follow-up after RT has been recently noted. Further prospective studies are needed to define better the course of HCV infection among renal allograft recipients.
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