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  • Review Article
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Chronic viral hepatitis in kidney transplantation

Nature Reviews Nephrology volume 7, pages 156–165 (2011)Cite this article

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Abstract

Chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection in potential kidney transplant candidates—once considered absolute contraindications to kidney transplantation—no longer creates overt barriers to transplantation. Advances in the medical management of HBV and HCV infection have created opportunities for a substantial number of patients to be effectively treated with antiviral therapy before transplantation. For HBV infection, a number of new drugs enable clearance of the virus with minimal adverse effects and drug resistance. Pretransplantation antiviral therapy is advisable for patients with HCV infection, but adverse effects are common and viral eradication remains challenging. Regardless of viral clearance, pretransplant patients without bridging fibrosis (as confirmed by liver biopsy) or clinical stigmata of cirrhosis should be considered for kidney transplantation as survival is superior when compared to treatment with dialysis, and progression of liver disease is unlikely. For patients with advanced liver disease, simultaneous liver–kidney transplantation is an important consideration. These treatment advances further increase the burden of organ donor shortage; however, organs from deceased donors with chronic HBV or HCV infection could be efficiently allocated to certain individuals with a viral infection of the same type to increase the pool of available transplant organs.

Key Points

  • The presence of chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection is rarely an exclusion criterion for kidney transplantation

  • Chronic, active HBV infection should be treated both before and after kidney transplantation without cessation of antiviral therapy

  • Patients with HBV or HCV infection without overt clinical features of cirrhosis should undergo liver biopsy as part of pretransplantation evaluation

  • Antiviral therapy for chronic, active HCV infection should be attempted before kidney transplantation

  • Kidneys from deceased donors infected with HCV should be efficiently allocated to patients with chronic HCV infection to minimize time on dialysis and improve organ utilization

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Figure 1: Proposed algorithm for pretransplantation and post-transplantation management of HCV-infected kidney transplant patients.

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Authors and Affiliations

  1. Division of Renal Diseases and Hypertension, University of Colorado Denver, 1635 North Aurora Court, Mail Stop F749, Aurora, 80045, CO, USA

    Janna Huskey

  2. Transplant Center, University of Colorado Denver, 1635 North Aurora Court, Mail Stop F749, Aurora, 80045, CO, USA

    Alexander C. Wiseman

Authors
  1. Janna Huskey
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  2. Alexander C. Wiseman
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J. Huskey and A. C. Wiseman contributed equally to all aspects of this manuscript.

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Correspondence to Alexander C. Wiseman.

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The authors declare no competing financial interests.

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Huskey, J., Wiseman, A. Chronic viral hepatitis in kidney transplantation. Nat Rev Nephrol 7, 156–165 (2011). https://doi.org/10.1038/nrneph.2010.192

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