Hepatitis C virus infection in haemodialysis and kidney transplant patients.
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.
Department of Nephrology and Medical Intensive Care, Campus Virchow-Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany. seema.baid-agrawal@charite.de
Seema
S
Baid-Agrawal
Manuel
M
Pascual
Darius
D
Moradpour
Ulrich
U
Frei
Nina
N
Tolkoff-Rubin
D000998:Antiviral Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D018450:Disease Progression; D004359:Drug Therapy, Combination; D016174:Hepacivirus / Q000187:drug effects; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D011092:Polyethylene Glycols / Q000627:therapeutic use; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D012254:Ribavirin / Q000627:therapeutic use; D016019:Survival Analysis; D016896:Treatment Outcome
D000998:Antiviral Agents; D016898:Interferon-alpha; D011092:Polyethylene Glycols; D012254:Ribavirin