Hepatitis C and renal transplantation

Hepatitis C is a widespread problem, and the prevalence is higher in patients on hemodialysis than in the general population. In addition, hepatitis C reduces survival in dialysis patients and renal-transplant recipients. Kidney transplantation offers a survival advantage to those patients with chronic hepatitis C infection faced with the alternative of remaining on dialysis. Kidney transplantation should therefore be considered the treatment of choice for patients with end-stage renal disease and hepatitis C infection. However, these patients need to be chosen appropriately, and there are no well-established guidelines for the workup or selection of these of these patients. Liver biopsy is an essential tool to determine the degree of fibrosis in these patients and also will prove useful in the management of the patients after transplantation. Transplantation of kidneys from hepatitis C-positive donors to hepatitis C-positive recipients has been shown to be safe and confers a significant advantage in terms of waiting time in this population where death on the waiting list is significant. Treatment prior to transplantation should be considered by the hepatology team, although it is often more difficult to treat given the constraints of a patient in renal failure. Although interferon treatment in hepatitis C-positive kidney-transplant candidates is recommended, treatment posttransplant remains controversial. Simultaneous kidney/liver transplantation should be considered for those candidates with evidence of portal hypertension or decompensated cirrhosis.