Current Status of Renal Transplantation from Hcv-Positive Donors

Abstract

Hepatitis C virus (HCV) infection remains frequent among renal transplant (RT) recipients and has a detrimental effect on patient and graft survival. Accelerated progression of liver disease due to HCV has been implicated in increased mortality after kidney transplantation but additional outcomes have been related to HCV after RT. All HCV-infected kidney transplant candidates should be considered for liver biopsy before RT. HCV infection should not be considered an absolute contraindication to renal transplantation, although the course of HCV-related liver disease is often progressive. Numerous organ procurement organizations have introduced the policy of accepting kidneys from HCV-positive donors for HCV-positive recipients, but this is still controversial. Single-center experiences have not reported adverse effects on the short-term patient and graft survival, however information from large databases has suggested that RT recipients of HCV-positive donors are independently at risk of mortality even in the modern era of immunosuppression. Renal transplantation should be considered using HCV-seropositive grafts for qualified patients with chronic kidney disease (CKD) stage 5 and HCV infection since good information indicates that the transplantation of kidneys from HCV-infected donors results in improved survival compared to wait-listed and dialysis-dependent candidates. A potential risk related to the use of donor HCV-positive kidneys cannot be excluded, and kidneys from HCV-infected donors should be restricted to recipients with evidence of active viremia at the time of kidney transplantation.

Underutilization of Hepatitis C-Positive Kidneys for Hepatitis C-Positive Recipients

“…On the donor side, it is possible that the increase in death and graft loss may be more significant in recipients of kidneys from donors who are HCV viremic. On the recipient side, a recent review recommended restricting the use of HCV(+) kidneys to recipients with active HCV viremia (28). Further studies are needed to better understand the relationship between HCV viremia and outcomes.…”

Viral Transmission in Organ Transplantation: The Importance of Risk Assessment

“…HCV-positive donor organs can also be used in HCV-positive recipients with minimal impact on clinical outcomes [50,51]. Clinical studies have shown that there is no significant difference in survival in HCV-positive recipients who receive either HCV-positive or HCV-negative livers or kidneys [51][52][53][54][55]. Therefore, there needs to be education to enhance uptake of HCVpositive organs in HCV-positive recipients.…”

Marginal Donors in Renal Transplantation

“…Although there are some risks involved, the survival rate of renal transplant patients received kidneys from HCVpositive donors were reported to be better than dialysis [56,57]. However, recent literature highlighted the possibility of HCV transmission from the donor graft.…”