Hepatitis C in patients with renal transplantation

Hippokratia 2001, 5(1):3-12

Gr Miserlis


HCV infection is a usual and significant problem either in the patient with end-stage renal disease or in the renal transplant recipient. Nosocomial transmission of HCV in the dialysis unit is a risk factor for HCV infection. HCV positive patients should be tested for HCV RNA to document active infection. Management of HCV RNA positive patients on the waiting list, includes liver biopsy before renal transplantation to provide interferon  treatment if chronic active hepatitis is present. After transplantation, liver disease is more frequent in HCV positive patients than in HCV negative patients. In the long term, this leads to significant liver and renal graft complications. The patients have a higher risk of developing proteinuria and infections. Long terrn patient and renal graft survival rates are lower in HCV positive than in HCV negative renal graft recipients. Mortality because of liver disease and infections is higher in these patients. Nevertheless, renal transplantation is the best option for the HCV positive patient with end-stage renal disease. Transplantation of HCV positive kidneys should be offered to HCV positive recipients. Adjustment of immunosuppression and careful follow-up for early detection of proteinuria, infection, and worsening of liver disease is mandatory.