Hepatitis C virus infection in haemodialysis and kidney transplant patients

Abstract

Chronic infection with hepatitis C virus (HCV) is an important global health problem. The prevalence of HCV is significantly higher in haemodialysis and kidney transplant patients, as compared to the general population. In spite of the relatively milder liver disease activity reported in HCV-infected haemodialysis patients, HCV infection adversely affects survival. Likewise, HCV has a detrimental effect on both patient and graft survival after kidney transplantation. However, patient survival is significantly better with kidney transplantation compared to remaining on dialysis; therefore, HCV infection alone should not be a contraindication to transplantation. Combination antiviral therapy with pegylated interferon-alpha and low-dose ribavirin is currently evolving in haemodialysis patients. Interferon-alpha (standard/pegylated) is relatively contraindicated after kidney transplantation because of an increased risk of allograft rejection. Therefore, antiviral treatment of transplant candidates while on dialysis remains the best option and may avoid the risk of HCV-associated liver and renal disease after transplantation. Large multi-centre clinical trials are required in HCV-infected haemodialysis and kidney transplant patients in order to define optimal therapeutic strategies before and after transplantation.

Hepatitis C virus genotypes in hemodialysis patients in the Federal District, Brazil

“…These patients have an increased tendency to become HCV chronic carriers and also to be a potential reservoir for its transmission, possibly contributing to the nosocomial spread of HCV in dialysis centers 5,13 . In addition, hepatitis C seems to increase the mortality rate in this group of patients 4,20 .…”

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“…11 Transmission is via blood contact and consequently is higher in hemodialysis patients who later receive a kidney transplant than in the general population. 3 Multiple complications can occur as a result of being HCV+ in kidney transplant patients, including liver disease, de novo and recurrent glomerulonephritis and new-onset type 2 diabetes mellitus. These complications may affect graft and patient survival.…”

“…1 The prevalence of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) and in kidney transplant recipients is significantly higher than in the general population, 2,3 and it is associated with increased morbidity and mortality. 3 The United States Renal Data System (USRDS) analysis of 36 956 patients between 1996 and 2001 demonstrated a 6.8% prevalence of HCV infection 4 among kidney transplant recipients.…”

Hepatitis C Virus Infection in Chronic Kidney Disease

“…30 Thus, although it is important to recognize that HCVinfected kidney recipients have an increased hazard ratio for death, transplant continues to offer these patients a significantly improved survival compared with remaining on dialysis. [25][26][27][28][29]31 HCV and KT HCV infection is the primary cause of liver disease in KT recipients 32 ; however, it has also been associated with important extrahepatic manifestations that contribute to increased morbidity and mortality after transplantation. 33 HCVinfected recipients are at increased risk of de novo and recurrent membranous nephropathy, membranoproliferative GN, [34][35][36] and transplant glomerulopathy.…”