Transplantation in the patient with hepatitis C

Abstract

Summary Hepatitis C virus (HCV) infection is the most frequent cause of liver disease after renal transplantation. Its clinical course is irrelevant in the short term, except for rare cases of fibrosing cholestatic hepatitis. However, in the long run, HCV infection can lead to major liver complications. Because interferon (IFN) is generally contraindicated in renal transplant patients, the best approach is to treat patients on dialysis. Until more information with pegylated‐IFN is available, the use of alpha‐IFN monotherapy is recommended. Most of the patients with sustained virological response remain HCV RNA negative after transplantation. HCV‐positive renal transplant patients have a higher risk for proteinuria, chronic rejection, infections and post‐transplant diabetes (PTDM). Long‐term patient‐ and graft‐survival rates are lower in HCV‐positive patients. Mortality is higher, mainly as a result of liver disease and infections. HCV can contribute to the development of certain neoplasias such as post‐transplant lymphoproliferative disease (PTLD). HCV infection is also an independent risk factor for graft loss. PTDM, transplant glomerulopathy and HCV‐related glomerulonephritis can contribute to graft failure. Despite this, transplantation is the best option for end‐stage renal disease in HCV‐positive patients. Several measures to minimize the consequences of HCV infection have been recommended. Adjustment of immunosuppression and careful follow up in the outpatient clinic for early detection of HCV‐related complications are mandatory.

Survival Advantage of Kidney Transplantation Over Dialysis in Patients With Hepatitis C

“…In contrast, deaths from infectious complications in the waiting list patients were lower when compared with the kidney transplant recipients (20% vs. 40.5%) (25). The results from our and prior studies (26,27) suggest more efforts to reduce infectious complications after kidney transplantation are required.…”

Common Infections in Kidney Transplant Recipients

“…Ribavirin is generally contraindicated in renal failure because of the risk for hemolytic anemia, and there is insufficient data on newer protease inhibitor treatments in patients with renal failure. Patients with a sustained virologic response to pretransplant treatment with interferon have a reduced risk for HCV recurrence and decreased post-transplant GN (60). IFNa is associated with an increased risk for allograft dysfunction and rejection, making post-transplant treatment more difficult.…”

Untitled

“…This agrees the majority of published short-term series [27][28][29] and long-term ones. 20,30 Conversely, her short-term 26 and long-term studies 18,23 have demonstrated significantly inferior graft survival in viremic recipients. Other studies document lower graft survival in nonviremic recipients.…”

“…viremic group. 23,24 Also Baid-Agrawal 25 suggests that impaired peripheral insulin sensitivity is associated with HCV infection irrespective of the transplant status, and is the most likely pathogenic mechanism involved in the development of type 2 diabetes mellitus associated with HCV infection. This variation in reported incidence may be related to the varying definitions of diabetes used in the literature, duration of follow-up, presence of other modifiable, and nonmodifiable risk factors.…”