Hepatitis C Infection in Kidney Transplantion

Abstract

Hepatitis C is one of the commonest chronic viral infections world-wide and has major health‐ care implications. According to World Health Organization (WHO), the estimated prevalence of chronic HCV infection world-wide ranges from 0.1% to more than 12%, equating to approxi‐ mately 170 million chronic carriers and incidence of 3-4 million new cases per year (Carbone et al., 2011). Chronic kidney disease (CKD) in general is present in approximately 10% of the population with many of these patients requiring renal replacement therapy in the form of dialysis and or kidney transplant. A major cause of morbidity and mortality in dialysis patients and kidney transplant recipients is liver disease secondary to hepatitis C virus (HCV) infection. The prevalence of HCV infection is high among renal transplant donors, recipients, and in end stage renal disease (ESRD) patients on dialysis. When HCV infection is present in this group of patients, it has major implications (Scott et al., 2010; Goodkin et al., 2003; Carbone et al., 2011). The major factors associated with this increased relative risk of HCV infection in dialysis patients as opposed to general population are overall exposure of blood products, age, and duration of dialysis (Periera & Levey, 1997; Finelli et al., 2005; Fissell et al., 2004). On the other hand, some recent reports indicate possible decline in prevalence of HCV infection in dialysis patients (Carbone et al., 2011; Scott et al., 2010; Finelli et al., 2005; Fissell et al., 2004; Jadoul et al., 2004; Fribrizi et al., 2002). This decline could be related to the use of erythropoiesis-stimulating agents that consequently lead to decrease in blood transfusions, and progressive enhancement of dialysis conditions to control infections. In developed countries, the prevalence of HCV infection is higher in renal trans‐ plant recipients than in dialysis patients, major contributing factors being longer survival of the former with more exposure to blood products, and most probably dialysis.