Hepatitis C infection in kidney transplant candidates and recipients
- Marion Muche, MD
Marion Muche, MD
- Charité - Medical University, Berlin, Germany
- Seema Baid-Agrawal, MD
Seema Baid-Agrawal, MD
- Associate Professor of Medicine
- Sahlgrenska Medical University, Gothenburg, Sweden
- Section Editors
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
- Adrian M Di Bisceglie, MD
Adrian M Di Bisceglie, MD
- Section Editor — Hepatitis C
- Chief of Hepatology
- Saint Louis University School of Medicine
Hepatitis C virus (HCV) causes renal disease in native and transplanted kidneys. HCV-infected renal transplant recipients have worse patient and allograft survival after transplantation compared with noninfected renal transplant recipients.
Early detection, prevention, and treatment of HCV-related renal disease after kidney transplantation could improve posttransplant outcomes in this population .
This topic reviews HCV infection in the renal transplant recipient. HCV infection among dialysis patients, in the renal transplant donor, and in the general population is discussed elsewhere. (See "Hepatitis C virus infection in kidney donors" and "Hepatitis C virus infection in patients on maintenance dialysis" and "Clinical manifestations and natural history of chronic hepatitis C virus infection" and "Diagnosis and evaluation of chronic hepatitis C virus infection" and "Overview of the management of chronic hepatitis C virus infection".)
The reported prevalence of HCV infection among renal transplant recipients is approximately 1.8 to 8 percent [2-6]. Most HCV-infected transplant recipients are infected prior to transplant, while on dialysis . The transmission of HCV through kidney transplantation is rare due to screening of donors . (See "Hepatitis C virus infection in kidney donors".)
HCV EVALUATION OF TRANSPLANT CANDIDATES
Screening for HCV infection — We agree with the 2008 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines that all transplant candidates should be screened for HCV infection . Transplant candidates who were previously successfully treated for HCV infection should be rescreened at least annually.
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: May 31, 2017.References
- Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl 2008; :S1.
- Kliem V, Burg M, Haller H, et al. Relationship of hepatitis B or C virus prevalences, risk factors, and outcomes in renal transplant recipients: analysis of German data. Transplant Proc 2008; 40:909.
- Scott DR, Wong JK, Spicer TS, et al. Adverse impact of hepatitis C virus infection on renal replacement therapy and renal transplant patients in Australia and New Zealand. Transplantation 2010; 90:1165.
- Santos L, Alves R, Macario F, et al. Impact of hepatitis B and C virus infections on kidney transplantation: a single center experience. Transplant Proc 2009; 41:880.
- Baid-Agrawal S, Pascual M, Moradpour D, et al. Hepatitis C virus infection and kidney transplantation in 2014: what's new? Am J Transplant 2014; 14:2206.
- Baid-Agrawal S, Schindler R, Reinke P, et al. Prevalence of occult hepatitis C infection in chronic hemodialysis and kidney transplant patients. J Hepatol 2014; 60:928.
- El-Sherif A, Elbahrawy A, Aboelfotoh A, et al. High false-negative rate of anti-HCV among Egyptian patients on regular hemodialysis. Hemodial Int 2012; 16:420.
- Mathurin P, Mouquet C, Poynard T, et al. Impact of hepatitis B and C virus on kidney transplantation outcome. Hepatology 1999; 29:257.
- Zylberberg H, Nalpas B, Carnot F, et al. Severe evolution of chronic hepatitis C in renal transplantation: a case control study. Nephrol Dial Transplant 2002; 17:129.
- Pawa S, Ehrinpreis M, Mutchnick M, et al. Percutaneous liver biopsy is safe in chronic hepatitis C patients with end-stage renal disease. Clin Gastroenterol Hepatol 2007; 5:1316.
- Ahmad A, Hasan F, Abdeen S, et al. Transjugular liver biopsy in patients with end-stage renal disease. J Vasc Interv Radiol 2004; 15:257.
- Eason JD, Gonwa TA, Davis CL, et al. Proceedings of Consensus Conference on Simultaneous Liver Kidney Transplantation (SLK). Am J Transplant 2008; 8:2243.
- Paramesh AS, Davis JY, Mallikarjun C, et al. Kidney transplantation alone in ESRD patients with hepatitis C cirrhosis. Transplantation 2012; 94:250.
- Parsikia A, Campos S, Khanmoradi K, et al. Equal 3-Year Outcomes for Kidney Transplantation Alone in HCV-Positive Patients With Cirrhosis. Int Surg 2015; 100:142.
- Periera BJ, Wright TL, Schmid CH, Levey AS. The impact of pretransplantation hepatitis C infection on the outcome of renal transplantation. Transplantation 1995; 60:799.
- Stempel CA, Lake J, Kuo G, Vincenti F. Hepatitis C--its prevalence in end-stage renal failure patients and clinical course after kidney transplantation. Transplantation 1993; 55:273.
- Roth D, Zucker K, Cirocco R, et al. The impact of hepatitis C virus infection on renal allograft recipients. Kidney Int 1994; 45:238.
- Ynares C, Johnson HK, Kerlin T, et al. Impact of pretransplant hepatitis C antibody status upon long-term patient and renal allograft survival--a 5- and 10-year follow-up. Transplant Proc 1993; 25:1466.
- Fritsche C, Brandes JC, Delaney SR, et al. Hepatitis C is a poor prognostic indicator in black kidney transplant recipients. Transplantation 1993; 55:1283.
- Lee SW, Kang SW, Choi KH, et al. Clinical outcome of anti-HCV(+) renal allograft recipients. Transplant Proc 1996; 28:1501.
- Toth CM, Pascual M, Chung RT, et al. Hepatitis C virus-associated fibrosing cholestatic hepatitis after renal transplantation: response to interferon-alpha therapy. Transplantation 1998; 66:1254.
- Muñoz De Bustillo E, Ibarrola C, Colina F, et al. Fibrosing cholestatic hepatitis in hepatitis C virus-infected renal transplant recipients. J Am Soc Nephrol 1998; 9:1109.
- Roth D, Gaynor JJ, Reddy KR, et al. Effect of kidney transplantation on outcomes among patients with hepatitis C. J Am Soc Nephrol 2011; 22:1152.
- Alric L, Di-Martino V, Selves J, et al. Long-term impact of renal transplantation on liver fibrosis during hepatitis C virus infection. Gastroenterology 2002; 123:1494.
- Manuel O, Baid-Agrawal S, Moradpour D, Pascual M. Immunosuppression in hepatitis C virus-infected patients after kidney transplantation. Contrib Nephrol 2012; 176:97.
- European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56:908.
- Burstein DM, Rodby RA. Membranoproliferative glomerulonephritis associated with hepatitis C virus infection. J Am Soc Nephrol 1993; 4:1288.
- Rahamimov R, Ilan Y, Eid A, et al. Hepatitis C-associated cryoglobulinemia after liver transplantation. Transplantation 1995; 60:1050.
- Cantarell MC, Charco R, Capdevila L, et al. Outcome of hepatitis C virus-associated membranoproliferative glomerulonephritis after liver transplantation. Transplantation 1999; 68:1131.
- Cruzado JM, Carrera M, Torras J, Grinyó JM. Hepatitis C virus infection and de novo glomerular lesions in renal allografts. Am J Transplant 2001; 1:171.
- Hammoud H, Haem J, Laurent B, et al. Glomerular disease during HCV infection in renal transplantation. Nephrol Dial Transplant 1996; 11 Suppl 4:54.
- Roth D, Cirocco R, Zucker K, et al. De novo membranoproliferative glomerulonephritis in hepatitis C virus-infected renal allograft recipients. Transplantation 1995; 59:1676.
- Cruzado JM, Gil-Vernet S, Ercilla G, et al. Hepatitis C virus-associated membranoproliferative glomerulonephritis in renal allografts. J Am Soc Nephrol 1996; 7:2469.
- Gallay BJ, Alpers CE, Davis CL, et al. Glomerulonephritis in renal allografts associated with hepatitis C infection: a possible relationship with transplant glomerulopathy in two cases. Am J Kidney Dis 1995; 26:662.
- Morales JM, Pascual-Capdevila J, Campistol JM, et al. Membranous glomerulonephritis associated with hepatitis C virus infection in renal transplant patients. Transplantation 1997; 63:1634.
- Baid S, Pascual M, Williams WW Jr, et al. Renal thrombotic microangiopathy associated with anticardiolipin antibodies in hepatitis C-positive renal allograft recipients. J Am Soc Nephrol 1999; 10:146.
- Baid-Agrawal S, Farris AB 3rd, Pascual M, et al. Overlapping pathways to transplant glomerulopathy: chronic humoral rejection, hepatitis C infection, and thrombotic microangiopathy. Kidney Int 2011; 80:879.
- Cosio FG, Roche Z, Agarwal A, et al. Prevalence of hepatitis C in patients with idiopathic glomerulopathies in native and transplant kidneys. Am J Kidney Dis 1996; 28:752.
- Cosio FG, Sedmak DD, Henry ML, et al. The high prevalence of severe early posttransplant renal allograft pathology in hepatitis C positive recipients. Transplantation 1996; 62:1054.
- Gloor JM, Sethi S, Stegall MD, et al. Transplant glomerulopathy: subclinical incidence and association with alloantibody. Am J Transplant 2007; 7:2124.
- Fabrizi F, Martin P, Dixit V, et al. Post-transplant diabetes mellitus and HCV seropositive status after renal transplantation: meta-analysis of clinical studies. Am J Transplant 2005; 5:2433.
- Kamar N, Toupance O, Buchler M, et al. Evidence that clearance of hepatitis C virus RNA after alpha-interferon therapy in dialysis patients is sustained after renal transplantation. J Am Soc Nephrol 2003; 14:2092.
- Delgado-Borrego A, Casson D, Schoenfeld D, et al. Hepatitis C virus is independently associated with increased insulin resistance after liver transplantation. Transplantation 2004; 77:703.
- Shintani Y, Fujie H, Miyoshi H, et al. Hepatitis C virus infection and diabetes: direct involvement of the virus in the development of insulin resistance. Gastroenterology 2004; 126:840.
- Baid-Agrawal S, Frei U, Reinke P, et al. Impaired insulin sensitivity as an underlying mechanism linking hepatitis C and posttransplant diabetes mellitus in kidney recipients. Am J Transplant 2009; 9:2777.
- Burra P, Buda A, Livi U, et al. Occurrence of post-transplant lymphoproliferative disorders among over thousand adult recipients: any role for hepatitis C infection? Eur J Gastroenterol Hepatol 2006; 18:1065.
- Aravindan AN, Moger V, Sakhuja V, et al. Hepatitis C virus related lymphoproliferative disorder in a renal transplant recipient. Int Urol Nephrol 2006; 38:355.
- Caillard S, Lelong C, Pessione F, et al. Post-transplant lymphoproliferative disorders occurring after renal transplantation in adults: report of 230 cases from the French Registry. Am J Transplant 2006; 6:2735.
- Brunkhorst R, Kliem V, Koch KM. Recurrence of membranoproliferative glomerulonephritis after renal transplantation in a patient with chronic hepatitis C. Nephron 1996; 72:465.
- Hestin D, Guillemin F, Castin N, et al. Pretransplant hepatitis C virus infection: a predictor of proteinuria after renal transplantation. Transplantation 1998; 65:741.
- Mahmoud IM, Elhabashi AF, Elsawy E, et al. The impact of hepatitis C virus viremia on renal graft and patient survival: a 9-year prospective study. Am J Kidney Dis 2004; 43:131.
- Romero E, Galindo P, Bravo JA, et al. Hepatitis C virus infection after renal transplantation. Transplant Proc 2008; 40:2933.
- Recommendations for Testing, Managing, and Treating Hepatitis C. Joint panel from the American Association of the Study of Liver Diseases and the Infectious Diseases Society of America. http://www.hcvguidelines.org/ (Accessed on August 01, 2016).
- European Association for the Study of the Liver. Electronic address: firstname.lastname@example.org. EASL Recommendations on Treatment of Hepatitis C 2016. J Hepatol 2017; 66:153.
- World Health Organization. Guidelines for the screening, care, adn treatment of persons with hepatitis C infection. April 2014. http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 (Accessed on April 14, 2014).
- Bhamidimarri KR, Ladino M, Pedraza F, et al. Transplantation of kidneys from hepatitis C-positive donors into hepatitis C virus-infected recipients followed by early initiation of direct acting antiviral therapy: a single-center retrospective study. Transpl Int 2017.
- Gallegos-Orozco JF, Kim R, Thiesset HF, et al. Early Results of Pilot Study Using Hepatitis C Virus (HCV) Positive Kidneys to Transplant HCV Infected Patients with End-Stage Renal Disease Allowing for Successful Interferon-Free Direct Acting Antiviral Therapy after Transplantation. Cureus 2016; 8:e890.
- Sawinski D, Patel N, Appolo B, Bloom R. Use of HCV+ Donors Does Not Affect HCV Clearance With Directly Acting Antiviral Therapy But Shortens the Wait Time to Kidney Transplantation. Transplantation 2017; 101:968.
- Sawinski D, Kaur N, Ajeti A, et al. Successful Treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents. Am J Transplant 2016; 16:1588.
- Kamar N, Marion O, Rostaing L, et al. Efficacy and Safety of Sofosbuvir-Based Antiviral Therapy to Treat Hepatitis C Virus Infection After Kidney Transplantation. Am J Transplant 2016; 16:1474.
- Colombo M, Aghemo A, Liu H, et al. Treatment With Ledipasvir-Sofosbuvir for 12 or 24 Weeks in Kidney Transplant Recipients With Chronic Hepatitis C Virus Genotype 1 or 4 Infection: A Randomized Trial. Ann Intern Med 2017; 166:109.
- Fernández I, Muñoz-Gómez R, Pascasio JM, et al. Efficacy and tolerability of interferon-free antiviral therapy in kidney transplant recipients with chronic hepatitis C. J Hepatol 2017; 66:718.
- Gentil MA, González-Corvillo C, Perelló M, et al. Hepatitis C Treatment With Direct-Acting Antivirals in Kidney Transplant: Preliminary Results From a Multicenter Study. Transplant Proc 2016; 48:2944.
- Charlton M, Everson GT, Flamm SL, et al. Ledipasvir and Sofosbuvir Plus Ribavirin for Treatment of HCV Infection in Patients With Advanced Liver Disease. Gastroenterology 2015; 149:649.
- Gutierrez JA, Carrion AF, Avalos D, et al. Sofosbuvir and simeprevir for treatment of hepatitis C virus infection in liver transplant recipients. Liver Transpl 2015; 21:823.
- Pungpapong S, Aqel B, Leise M, et al. Multicenter experience using simeprevir and sofosbuvir with or without ribavirin to treat hepatitis C genotype 1 after liver transplant. Hepatology 2015; 61:1880.
- Saab S, Greenberg A, Li E, et al. Sofosbuvir and simeprevir is effective for recurrent hepatitis C in liver transplant recipients. Liver Int 2015; 35:2442.
- Kwo PY, Mantry PS, Coakley E, et al. An interferon-free antiviral regimen for HCV after liver transplantation. N Engl J Med 2014; 371:2375.
- Ozgür O, Boyacioğlu S, Telatar H, Haberal M. Recombinant alpha-interferon in renal allograft recipients with chronic hepatitis C. Nephrol Dial Transplant 1995; 10:2104.
- Harihara Y, Kurooka Y, Yanagisawa T, et al. Interferon therapy in renal allograft recipients with chronic hepatitis C. Transplant Proc 1994; 26:2075.
- Rostaing L, Izopet J, Baron E, et al. Preliminary results of treatment of chronic hepatitis C with recombinant interferon alpha in renal transplant patients. Nephrol Dial Transplant 1995; 10 Suppl 6:93.
- Chan TM, Lok AS, Cheng IK, Ng IO. Chronic hepatitis C after renal transplantation. Treatment with alpha-interferon. Transplantation 1993; 56:1095.
- Fabrizi F, Penatti A, Messa P, Martin P. Treatment of hepatitis C after kidney transplant: a pooled analysis of observational studies. J Med Virol 2014; 86:933.
- Wei F, Liu J, Liu F, et al. Interferon-based anti-viral therapy for hepatitis C virus infection after renal transplantation: an updated meta-analysis. PLoS One 2014; 9:e90611.
- Sperl J, Petrasek J, Spicak J, Viklicky O. Acute rejection of non-functional allograft in kidney transplant recipients with hepatitis C treated with peginterferon-alpha 2a. J Hepatol 2008; 49:461.
- Wéclawiack H, Kamar N, Mehrenberger M, et al. Alpha-interferon therapy for chronic hepatitis C may induce acute allograft rejection in kidney transplant patients with failed allografts. Nephrol Dial Transplant 2008; 23:1043.
- Martin MT, Koppe S. Elbasvir/Grazoprevir Use in Postliver Transplantation Patients on Hemodialysis. Transplantation 2017.
- American Association of the Study of Liver Disease (AASLD) guidelines. http://www.hcvguidelines.org (Accessed on May 04, 2015).
- Kiser JJ, Burton JR Jr, Everson GT. Drug-drug interactions during antiviral therapy for chronic hepatitis C. Nat Rev Gastroenterol Hepatol 2013; 10:596.
- Mogalian E, German P, Kearney BP, et al. Use of Multiple Probes to Assess Transporter- and Cytochrome P450-Mediated Drug-Drug Interaction Potential of the Pangenotypic HCV NS5A Inhibitor Velpatasvir. Clin Pharmacokinet 2016; 55:605.
- Mogalian E, Shen G, Moorehead L, et al. Drug-drug interaction profile of sofosbuvir/velpatasvir fixed-dose combination. Presented at the 51st Annual Meeting of the European Association for the Study of the Liver (EASL), Barcelona, Spain, April 13-17, 2016.
- Zaltzman JS, Nash M, Chiu R, Prasad R. The benefits of renin-angiotensin blockade in renal transplant recipients with biopsy-proven allograft nephropathy. Nephrol Dial Transplant 2004; 19:940.
- Montanaro D, Gropuzzo M, Tulissi P, et al. Renoprotective effect of early inhibition of the renin-angiotensin system in renal transplant recipients. Transplant Proc 2005; 37:991.
- Heinze G, Mitterbauer C, Regele H, et al. Angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor antagonist therapy is associated with prolonged patient and graft survival after renal transplantation. J Am Soc Nephrol 2006; 17:889.
- Fabrizi F, Martin P, Dixit V, et al. Hepatitis C virus antibody status and survival after renal transplantation: meta-analysis of observational studies. Am J Transplant 2005; 5:1452.
- Fabrizi F, Martin P, Dixit V, Messa P. Meta-analysis of observational studies: hepatitis C and survival after renal transplant. J Viral Hepat 2014; 21:314.
- Rostami Z, Nourbala MH, Alavian SM, et al. The impact of Hepatitis C virus infection on kidney transplantation outcomes: A systematic review of 18 observational studies: The impact of HCV on renal transplantation. Hepat Mon 2011; 11:247.
- Pereira BJ, Natov SN, Bouthot BA, et al. Effects of hepatitis C infection and renal transplantation on survival in end-stage renal disease. The New England Organ Bank Hepatitis C Study Group. Kidney Int 1998; 53:1374.
- Knoll GA, Tankersley MR, Lee JY, et al. The impact of renal transplantation on survival in hepatitis C-positive end-stage renal disease patients. Am J Kidney Dis 1997; 29:608.
- Maluf DG, Fisher RA, King AL, et al. Hepatitis C virus infection and kidney transplantation: predictors of patient and graft survival. Transplantation 2007; 83:853.
- Ingsathit A, Kamanamool N, Thakkinstian A, Sumethkul V. Survival advantage of kidney transplantation over dialysis in patients with hepatitis C: a systematic review and meta-analysis. Transplantation 2013; 95:943.
- Natov SN, Lau JY, Ruthazer R, et al. Hepatitis C virus genotype does not affect patient survival among renal transplant candidates. The New England Organ Bank Hepatitis C Study Group. Kidney Int 1999; 56:700.
- Kanwal F, Kramer JR, Ilyas J, et al. HCV genotype 3 is associated with an increased risk of cirrhosis and hepatocellular cancer in a national sample of U.S. Veterans with HCV. Hepatology 2014; 60:98.
- Campos-Varela I, Lai JC, Verna EC, et al. Hepatitis C genotype influences post-liver transplant outcomes. Transplantation 2015; 99:835.
- HCV EVALUATION OF TRANSPLANT CANDIDATES
- Screening for HCV infection
- Liver biopsy for HCV-infected patients
- Pre-HCV treatment evaluation
- COMPLICATIONS AFTER TRANSPLANTATION
- Liver disease
- Renal disease
- New-onset diabetes after transplantation
- Posttransplant lymphoproliferative disorder
- MONITORING AFTER TRANSPLANTATION
- ANTIVIRAL TREATMENT
- Timing of treatment
- Regimen selection before transplantation
- Regimen selection after transplantation
- - eGFR >30 mL/min/1.73 m2
- - eGFR <30 mL/min/1.73 m2
- - Interactions with immunosuppressive agents
- TREATMENT WITH ANTIPROTEINURIC AGENTS
- Compared with HCV-negative transplant recipients
- Compared with dialysis
- Effect of HCV genotype on survival after renal transplantation
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS