Current status of renal transplantation from HCV-positive donors

Area of Science:

• Nephrology
• Hepatology
• Transplantation Immunology

Background:

• Hepatitis C virus (HCV) infection is common in renal transplant (RT) recipients, negatively impacting patient and graft survival.
• HCV accelerates liver disease progression, increasing mortality post-kidney transplantation.
• HCV infection is not an absolute contraindication for renal transplantation, despite often progressive liver disease.

Purpose of the Study:

• To evaluate the outcomes of renal transplantation in Hepatitis C virus (HCV)-infected recipients.
• To assess the safety and efficacy of using HCV-positive donor kidneys for HCV-positive recipients.
• To provide guidance on kidney transplantation strategies for patients with HCV infection.

Main Methods:

• Review of outcomes in renal transplant recipients with HCV infection.
• Analysis of data regarding the use of HCV-positive donor kidneys in HCV-positive recipients.
• Comparison of survival rates between transplanted patients and those on dialysis or wait-listed.

Main Results:

• While single-center studies show no short-term adverse effects, large databases suggest RT recipients of HCV-positive donors face an independent mortality risk.
• Transplantation of kidneys from HCV-infected donors may improve survival for qualified patients with chronic kidney disease (CKD) stage 5 and HCV infection compared to dialysis.
• A potential risk exists with HCV-positive donor kidneys, suggesting restriction to recipients with active viremia.

Conclusions:

• HCV infection requires careful consideration in renal transplant candidates, including pre-transplant liver biopsy.
• Accepting kidneys from HCV-positive donors for HCV-positive recipients is controversial but may offer survival benefits over dialysis.
• Kidneys from HCV-infected donors should be prioritized for recipients with active HCV viremia to mitigate risks.