Hepatitis C and kidney transplantation

Area of Science:

• Nephrology
• Hepatology
• Transplantation

Background:

• Hepatitis C virus (HCV) infection is prevalent in patients with end-stage kidney disease (ESKD) undergoing dialysis and those who have received kidney transplants.
• HCV infection in hemodialysis patients correlates with higher mortality rates from liver cirrhosis and hepatocellular carcinoma.
• Assessing liver fibrosis severity in kidney transplant candidates with HCV is crucial for predicting post-transplant patient and graft survival.

Purpose of the Study:

• To review the impact of Hepatitis C virus infection on patients with end-stage kidney disease.
• To evaluate management strategies and outcomes for HCV-positive patients in the context of kidney disease and transplantation.
• To highlight the role of kidney transplantation as a treatment modality for HCV-infected ESKD patients.

Main Methods:

• Literature review focusing on Hepatitis C virus in ESKD patients, hemodialysis, and kidney transplantation.
• Analysis of data regarding mortality, liver disease progression, and transplant outcomes.
• Discussion of diagnostic methods like liver biopsy for fibrosis assessment.

Main Results:

• Kidney transplantation is superior to hemodialysis for managing HCV-positive ESKD patients.
• Transplanting kidneys from HCV-positive donors to HCV-positive recipients is safe and reduces waiting times.
• Simultaneous kidney/liver transplantation (SKL) is recommended for candidates with HCV-related decompensated cirrhosis.

Conclusions:

• Kidney transplantation is the preferred treatment for HCV-positive ESKD patients.
• Careful donor-recipient matching and consideration of combined transplants improve outcomes.
• HCV treatment is challenging in hemodialysis patients but effective in SLK recipients.