Management of the kidney transplant patient with chronic hepatitis C infection

Area of Science:

• Nephrology
• Hepatology
• Transplantation

Background:

• Chronic Hepatitis C (HCV) infection is a significant factor in morbidity and mortality for patients with end-stage renal disease.
• Renal transplantation offers improved survival for HCV-infected individuals.

Purpose of the Study:

• To outline management strategies for HCV-infected patients undergoing renal transplantation.
• To highlight the benefits of sustained virological response (SVR) and assess treatment options.

Main Methods:

• Evaluation of liver fibrosis and cirrhosis through liver biopsy in transplant candidates with HCV.
• Consideration of interferon-based therapy for eligible patients with fibrosis or compensated cirrhosis.
• Assessment of HCV-positive kidney transplantation for specific patient groups.

Main Results:

• Sustained virological response (SVR) can decrease post-transplant hepatic and extrahepatic complications, including glomerulonephritis.
• HCV-positive kidneys are an option for patients unable to achieve SVR without a live donor.
• Interferon use post-transplant is generally discouraged, except for severe liver injury.

Conclusions:

• Early detection and management of HCV complications are crucial for improving outcomes in kidney transplant recipients.
• Optimizing HCV treatment pre-transplant can mitigate risks and improve long-term survival.
• Personalized treatment strategies, including consideration of HCV-positive donors, are vital for this patient population.