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Hepatitis C virus infection in end-stage renal disease and kidney transplantation

Patrizia Burra1, Kryssia I Rodríguez-Castro, Francesco Marchini

  • 1Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.

Transplant International : Official Journal of the European Society for Organ Transplantation
|May 24, 2014
PubMed

Insights

Chronic hepatitis C virus (HCV) infection significantly impacts liver disease in patients with end-stage renal disease (ESRD) and kidney transplant (KT) recipients. Newer antiviral therapies offer improved outcomes, necessitating updated clinical guidelines for managing HCV in these vulnerable populations.

Area of Science:

  • Nephrology
  • Hepatology
  • Infectious Diseases

Background:

  • Chronic hepatitis C virus (HCV) infection is a major cause of liver disease, morbidity, and mortality in patients with end-stage renal disease (ESRD) and kidney transplant (KT) recipients.
  • Hemodialytic treatment (HD) for ESRD increases the risk of bloodborne infections like HCV due to prolonged vascular access and potential exposure.
  • HCV infection negatively impacts survival outcomes in KT recipients compared to HCV-negative individuals.

Purpose of the Study:

  • To evaluate the stage of liver disease and assess the appropriateness of antiviral therapy in HCV-positive ESRD and KT patients.
  • To highlight the challenges and evolving treatment strategies for HCV in patients with kidney disease.
  • To emphasize the need for comprehensive clinical practice guidelines for managing HCV in ESRD and KT patients.

Main Methods:

  • Review of current literature on HCV infection in ESRD and KT patients.
  • Analysis of the efficacy and safety of traditional and novel antiviral therapies, including direct-acting antiviral agents (DAAs).
  • Evaluation of treatment outcomes, tolerability, and impact on renal function and graft survival.

Main Results:

  • Interferon (IFN)-based antiviral therapy is often contraindicated post-transplantation due to rejection risks, making pre-transplant treatment crucial.
  • Newer combination DAAs demonstrate high sustained viral response rates, low resistance, and good safety profiles, including renal function preservation.
  • While KT improves outcomes over HD, HCV infection significantly reduces long-term survival post-transplantation.

Conclusions:

  • HCV infection poses significant risks for ESRD and KT patients, necessitating careful management and timely treatment.
  • Direct-acting antiviral agents represent a significant advancement in HCV therapy, offering better tolerability and efficacy in renal patients.
  • Development of comprehensive clinical practice guidelines is essential for optimizing the care of HCV-infected ESRD and KT patients.

Keywords:
end-stage renal diseasehepatitis C viruskidney transplant

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