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  • Review Article
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Hepatitis C and its impact on renal transplantation

Nature Reviews Nephrology volume 11, pages 172–182 (2015)Cite this article

Subjects

Key Points

  • Antiviral treatment should be considered for all patients with hepatitis C virus (HCV) infection and end-stage renal disease (ESRD)

  • Renal transplantation is the optimum choice of therapy for patients with HCV infection and ESRD

  • Patients that acquire HCV infection after renal transplantation have an increased risk of cirrhosis and hepatocarcinoma; progression of liver disease is slow and does not occur in all patients

  • Mortality is lower among patients who undergo renal transplantation compared to those remaining on the kidney transplant waiting list, regardless of HCV infection status

  • Graft survival is lower among patients with HCV infection, as compared to uninfected patients

  • Interferon-free regimens can substantially change the natural history of HCV infection after renal transplantation; multicentre and prospective studies using such therapies in patients with ESRD are in progress

Abstract

Infection with hepatitis C virus (HCV) is the major cause of chronic liver disease that occurs after renal transplantation. Such infection is often acquired during dialysis while patients wait to undergo renal transplantation. Renal transplantation is considered the best treatment option for patients with HCV infection and end-stage renal disease, although acceptance of a kidney graft by the host immune system and patient survival are lower compared to patients who test negative for HCV. The approval of interferon-free therapies could substantially change the natural history of HCV infection after renal transplantation. This Review discusses the interplay between renal transplantation, HCV infection, and liver disease. We emphasize the development of novel therapeutic strategies, including use of the newly identified direct-acting antiviral agents for treating hepatitis C among infected patients. We next analyse the most common clinical complications subsequent to HCV infection and the impact on graft and patient survival. Finally, we evaluate the consequences of kidney transplantation from HCV-positive donors.

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Figure 1: Hepatitis C virus (HCV) genome and selected drug targets.

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Acknowledgements

J.M.M.'s research is supported by a FISS 2012 (Spain) research grant, no 12/00108.

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  1. Immunology Department, Research Institute, Hospital 12 de Octubre, Avenida de Cordoba s/n, Madrid, 28401, Spain

    Jose M. Morales

  2. Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS Foundation, Via Francesco Sforza 33, Milano, 20122, Italy

    Fabrizio Fabrizi

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Both authors researched the data for the article, provided substantial contributions to discussions of its content, wrote the article and undertook review and/or editing of the manuscript before submission.

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Correspondence to Jose M. Morales.

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Supplementary Figure 1

Summary estimate for sustained viral response rate and 95% confidence intervals of combination antiviral therapy (pegylated–interferon plus ribavirin) for hepatitis C after renal transplantation. (PDF 332 kb)

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Morales, J., Fabrizi, F. Hepatitis C and its impact on renal transplantation. Nat Rev Nephrol 11, 172–182 (2015). https://doi.org/10.1038/nrneph.2015.5

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