Hepatitis C Virus and Nonliver Solid Organ Transplantation

Abstract

: Hepatitis C virus (HCV) infection is common in solid organ allograft recipients and is a significant cause of morbidity and mortality after transplantation, so effective management will improve outcomes. In this review, we discuss the extent of the problem associated with HCV infection in donors and kidney, heart, and lung transplant candidates and recipients and recommend follow-up and treatment.Patients with end-stage kidney disease without cirrhosis and selected patients with early-stage cirrhosis can be considered for kidney transplant alone. In HCV-infected kidney allograft recipients, the progression of fibrosis should be evaluated serially by Fibroscan or serologic measures of fibrosis. Transplantation of kidneys from HCV-positive donors should be restricted to HCV-positive recipients as it is associated with a reduced time waiting for a graft and does not affect posttransplant outcomes. Hepatitis C virus antiviral therapy should be considered for all HCV-RNA-positive kidney transplant candidates, irrespective of the baseline liver histopathology. Protease inhibitors have yet to be fully evaluated in patients with renal dysfunction and in the transplant population. As these agents may cause anemia in patients with normal renal function, tolerability may be a problem in patients with end-stage kidney disease.The impact of HCV infection on survival in heart and lung transplantation is unclear. Because of the shortage of organs, few HCV-infected patients are accepted for transplantation.Universal use of nucleic acid amplification testing (NAT) for the screening of potential organ donors should be reserved to high-risk donors. Assays that quantify HCV core antigen may become more cost-effective than NAT for the screening of potential organ donors.

Effect of HCV, HIV and Coinfection in Kidney Transplant Recipients: Mate Kidney Analyses

“…Treatment of patients with renal disease is challenging, however, because of medication side effects such as anemia with the use of ribavirin and protease inhibitors. Also, protease inhibitors have not been evaluated in the setting of significant renal dysfunction (34). In addition, the currently available protease inhibitors are only approved for use in patients infected with HCV genotype 1.…”

“…Pretransplant treatment of HCV has been recommended since patients who achieve a sustained virologic response before transplant are unlikely to experience HCV reactivation after KTX, and have a lower risk of developing liver disease and HCV-related glomerulonephritis (34,35). Additionally, since treatment for HCV posttransplantation with an interferon-containing regimen increases the risk of acute rejection, there is a strong imperative to treat HCVþ potential kidney transplant recipients irrespective of the degree of fibrosis.…”

Equal 3-Year Outcomes for Kidney Transplantation Alone in HCV-Positive Patients With Cirrhosis

“…10,19 Some authors recommend KTA for selected patients with early-stage cirrhosis. 20 In many large reports of HCV þ recipients, the liver is not histologically monitored or patients with cirrhosis are excluded outright. 9,21 Current recommendations to evaluate for combined kidney-liver transplantations in CCCs may not be the most appropriate allocation of resources.…”

A Single-Center Experience of Overseas Kidney Transplant for Immunologically High-Risk Patients

“…In patients with HCV, because the safety and effectiveness of antiviral treatment after KT have not yet been verified, more careful evaluation is important, and antiviral treatment should be considered before performing the transplant. 11 However, there are complex factors to be considered in the selection of hepatitis-positive donors, owing to issues with viral transmission and donor safety. Recent organ shortages have led to active use of kidneys from HBV-positive donors, especially in geographic areas in which HBV infection is endemic.…”