Chronic viral hepatitis in kidney transplantation

[okarol]

Review

Nature Reviews Nephrology, advance online publication, Published online 1 February 2011 | doi:10.1038/nrneph.2010.192

Subject Category: Transplant

Chronic viral hepatitis in kidney transplantation
Janna Huskey & Alexander C. Wiseman  About the authors

Abstract
Chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection in potential kidney transplant candidates—once considered absolute contraindications to kidney transplantation—no longer creates overt barriers to transplantation. Advances in the medical management of HBV and HCV infection have created opportunities for a substantial number of patients to be effectively treated with antiviral therapy before transplantation. For HBV infection, a number of new drugs enable clearance of the virus with minimal adverse effects and drug resistance. Pretransplantation antiviral therapy is advisable for patients with HCV infection, but adverse effects are common and viral eradication remains challenging. Regardless of viral clearance, pretransplant patients without bridging fibrosis (as confirmed by liver biopsy) or clinical stigmata of cirrhosis should be considered for kidney transplantation as survival is superior when compared to treatment with dialysis, and progression of liver disease is unlikely. For patients with advanced liver disease, simultaneous liver–kidney transplantation is an important consideration. These treatment advances further increase the burden of organ donor shortage; however, organs from deceased donors with chronic HBV or HCV infection could be efficiently allocated to certain individuals with a viral infection of the same type to increase the pool of available transplant organs.

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Author affiliations

J. Huskey & A. C. Wiseman
Division of Renal Diseases and Hypertension, University of Colorado Denver, 1635 North Aurora Court, Mail Stop F749, Aurora, CO 80045, USA (J. Huskey).  Transplant Center, University of Colorado Denver, 1635 North Aurora Court, Mail Stop F749, Aurora, CO 80045, USA (A. C. Wiseman).

Correspondence to: A. C. Wiseman alexander.wiseman@ucdenver.edu

Published online 1 February 2011

http://www.nature.com/nrneph/journal/vaop/ncurrent/abs/nrneph.2010.192.html