Update on the Management of Hepatitis C Virus Infection in the Setting of Chronic Kidney Disease and Kidney Transplantation

Abstract

Hepatitis C virus (HCV) infection is one of the major global health burdens. Chronic HCV infection can increase the risks of proteinuria and chronic kidney disease (CKD), as well as cause various types of glomerulonephritides. This article provides an update on the management of patients with HCV infection with CKD and a kidney transplantation. Newer direct-acting antiviral (DAA) agents are safe and effective in eliminating HCV infection in patients with CKD and in kidney transplant recipients. Society guidelines recommend elbasvir/grazoprevir and glecaprevir/pibrentasvir for HCV-infected patients with CKD stage 4 or 5, including patients on hemodialysis. Patients with CKD stages 1 to 3 with HCV infection can be treated with various sofosbuvir-based regimens. Major clinical trials have demonstrated the safety, efficacy, and feasibility of the use of DAA agents in treating HCVuninfected kidney transplant recipients of HCV-infected donors. The utilization of HCV-infected kidney donors may decrease kidney transplant waiting list mortality and reduce the donated kidney discard rate.

Keywords: Hepatitis C virus; chronic kidney disease; direct-acting antiviral agents; hepatitis C virus treatment; kidney transplant recipients; kidney transplantation.

Conflict of interest statement

Dr Latt would like to thank Dr Natalie Bzowej and Ochsner Multi-Organ Transplant Institute’s Quality Assurance and Performance Improvement Committee for the utilization of proposed management guidelines of HCV-infected donor allografts. Dr Latt has no relevant conflicts of interest to disclose.

Figures

Figure 1.

UNOS data trends of increasing HCV-infected kidney donors.

Figure 2.

Proposed management guidelines for kidney transplant recipients who receive kidneys from HCV antibody–positive, NAT-positive or -negative donors.