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Chronic viral hepatitis in kidney transplantation

Janna Huskey1, Alexander C Wiseman

  • 1Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, CO 80045, USA.

Nature Reviews. Nephrology
|February 2, 2011
PubMed

Insights

Kidney transplantation is now possible for patients with chronic hepatitis B (HBV) or C (HCV) infection due to advances in antiviral therapies. This improves survival compared to dialysis, even allowing organ sharing between infected donors and recipients.

Area of Science:

  • Nephrology
  • Hepatology
  • Transplantation Immunology

Background:

  • Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections were previously absolute contraindications for kidney transplantation.
  • Advances in antiviral therapies have transformed the management of HBV and HCV, creating new opportunities for potential kidney transplant recipients.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of kidney transplantation in patients with chronic HBV or HCV infection.
  • To discuss the role of pretransplantation antiviral therapy and organ allocation strategies for these patient populations.

Main Methods:

  • Review of current medical management strategies for HBV and HCV in kidney transplant candidates.
  • Analysis of patient survival and liver disease progression in transplanted versus dialysis patients.
  • Consideration of simultaneous liver-kidney transplantation for advanced liver disease.
  • Evaluation of organ allocation protocols using HBV/HCV-infected donor organs.

Main Results:

  • Effective antiviral therapies with minimal adverse effects and drug resistance are available for HBV infection.
  • Pretransplantation antiviral therapy for HCV infection shows promise but faces challenges with adverse effects and viral eradication.
  • Kidney transplantation offers superior survival compared to dialysis for patients without advanced liver disease.
  • Simultaneous liver-kidney transplantation is a viable option for patients with severe liver disease.
  • Utilizing organs from HBV/HCV-infected donors for serologically matched recipients can expand the donor pool.

Conclusions:

  • Chronic HBV and HCV infections are no longer absolute barriers to kidney transplantation.
  • Careful patient selection, optimized antiviral therapy, and strategic organ allocation are crucial for successful transplantation in these patients.
  • Kidney transplantation significantly improves survival for eligible patients with chronic viral hepatitis compared to long-term dialysis.

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