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Hepatitis C virus infection in haemodialysis and kidney transplant patients
Seema Baid-Agrawal1, Manuel Pascual, Darius Moradpour
1Department of Nephrology and Medical Intensive Care, Campus Virchow-Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany. seema.baid-agrawal@charite.de
Insights
Chronic hepatitis C virus (HCV) infection impacts survival in dialysis and kidney transplant patients. Treating HCV before transplantation is recommended, as antiviral therapy is risky post-transplant.
Area of Science:
- Nephrology
- Hepatology
- Virology
Background:
- Chronic hepatitis C virus (HCV) infection is a global health issue.
- HCV prevalence is elevated in haemodialysis and kidney transplant recipients.
- HCV negatively impacts survival and graft outcomes in these patient populations.
Purpose of the Study:
- To review the impact of HCV on haemodialysis and kidney transplant patients.
- To discuss current and evolving antiviral treatment strategies.
- To highlight the need for further clinical trials.
Main Methods:
- Literature review of HCV in renal disease patients.
- Analysis of survival and graft outcomes.
- Evaluation of antiviral therapy efficacy and safety.
Main Results:
- HCV infection adversely affects survival in haemodialysis patients.
- HCV negatively impacts patient and graft survival post-kidney transplantation.
- Kidney transplantation improves survival compared to dialysis, even with HCV.
- Interferon-based antiviral therapy poses risks post-transplantation.
Conclusions:
- HCV infection should not preclude kidney transplantation.
- Antiviral treatment before transplantation is the preferred strategy.
- Further multi-center trials are essential to optimize HCV treatment in these patients.
Abstract:
Chronic infection with hepatitis C virus (HCV) is an important global health problem. The prevalence of HCV is significantly higher in haemodialysis and kidney transplant patients, as compared to the general population. In spite of the relatively milder liver disease activity reported in HCV-infected haemodialysis patients, HCV infection adversely affects survival. Likewise, HCV has a detrimental effect on both patient and graft survival after kidney transplantation. However, patient survival is significantly better with kidney transplantation compared to remaining on dialysis; therefore, HCV infection alone should not be a contraindication to transplantation. Combination antiviral therapy with pegylated interferon-alpha and low-dose ribavirin is currently evolving in haemodialysis patients. Interferon-alpha (standard/pegylated) is relatively contraindicated after kidney transplantation because of an increased risk of allograft rejection. Therefore, antiviral treatment of transplant candidates while on dialysis remains the best option and may avoid the risk of HCV-associated liver and renal disease after transplantation. Large multi-centre clinical trials are required in HCV-infected haemodialysis and kidney transplant patients in order to define optimal therapeutic strategies before and after transplantation.
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