Hepatitis C and Kidney Transplantation
by Parul Patel, M.D., transplant nephrologist, and Vicki Martin, R.N., kidney transplant coordinator
Hepatitis C virus (HCV) affects an estimated 200 million people worldwide and is a leading cause of cirrhosis and liver cancer. Individuals can acquire the virus by contact with infected body fluids, including blood transfusions, sexual contact, and IV drug abuse from infected needles. Studies suggest that 10-15% of patients on dialysis are HCV positive.
Some individuals with HCV can naturally eliminate the virus while others have a chronic infection that can progress to liver failure in 20 or more years. Several genetic forms of the virus exist. Genotype 1 affects 75% of patients with HCV and is the least responsive to current treatment regimens. Treatment usually involves up to a year of therapy with a combination of interferon—a medication given as an injection under the skin—and ribavirin. Up to 50% of patients with genotype 1 can eventually be cured of the virus.
HCV Medications and Dialysis
Unfortunately, individuals on dialysis require reduced doses of interferon and ribavirin, and response rates can be lower than in patients with normal kidney function. Also, many patients are unable to tolerate the side effects of the medication (including low blood counts, flu-like illness, and depression) while others may refuse treatment or may not be considered candidates for treatment after discussing the risks and benefits with a liver specialist (hepatologist). Researchers are investigating new treatment options that may offer patients on dialysis a better response.
Kidney Transplant Offers Option
Although there is a potential for HCV-associated liver disease to progress more rapidly due to post-transplant medications, kidney transplantation is offered to many patients with HCV and ESRD to improve quality of life and perhaps survival compared to staying on dialysis.
Because of the well known shortage of donor kidneys and long waiting time to transplant, many transplant centers are exploring ways to expand the donor pool and offer earlier access to transplantation for certain groups of patients.
Kidneys from HCV-positive deceased donors may offer an alternative for some patients waiting for a deceased donor kidney. At California Pacific Medical Center, the Kidney Team is piloting a program to offer this option to selected patients with HCV. Patients with HCV genotype 1 who have minimal scarring on liver biopsy may be candidates to receive an HCV+ donor kidney. Patients may be notified by our pre-transplant coordinator and transplant nephrologists if they might be a candidate for this study. Care will be coordinated with a hepatologist and candidates may also be offered an opportunity to participate in a research study.
Recipient Criteria for HCV+ Donor Kidney Transplantation at California Pacific Medical Center
- Full evaluation and assessment by hepatologist
- HCV genotype 1
- Minimal scarring on liver biopsy
article from Fall Winter 2010 Kidney Review newsletter