Hepatitis C infection in renal transplantation: pathogenesis, current impact and emerging trends

Area of Science:

• Nephrology
• Hepatology
• Transplantation

Background:

• Hepatitis C virus (HCV) infection is prevalent in chronic kidney disease (CKD) patients, particularly those on hemodialysis and kidney transplant recipients.
• HCV infection is linked to increased mortality, morbidity, and can be an independent risk factor for CKD development.
• HCV poses significant risks for renal transplant recipients, causing hepatic and extrahepatic complications, and potentially leading to poorer long-term outcomes.

Purpose of the Study:

• To review and optimize treatment strategies for co-existing HCV infection in renal transplant recipients.
• To evaluate promising alternative treatment regimens for HCV in this vulnerable patient population.

Main Methods:

• Review of current literature on HCV prevalence, risk factors, and complications in CKD and renal transplant patients.
• Analysis of existing and emerging HCV treatment options, including direct-acting antivirals (DAAs).
• Evaluation of treatment guidelines and outcomes based on clinical practice.

Main Results:

• HCV infection is a significant comorbidity in renal transplant recipients, impacting graft survival and overall patient health.
• Pre-transplant HCV management is recommended to improve outcomes, though transplantation is not contraindicated if pre-treatment is not feasible.
• Advances in HCV treatment, including DAAs and combination therapies, offer improved sustained virological response rates.

Conclusions:

• Optimizing HCV treatment in renal transplant recipients is crucial for improving long-term outcomes and reducing complications.
• Emerging therapies, such as protease and polymerase inhibitors, show promise for effective HCV management in this population.
• A tailored approach to HCV treatment, considering individual patient factors and available therapeutic options, is essential.