Patient survival is significantly lower in hepatitis C virus (HCV)-positive compared to HCV-negative dialysis patients. After
renal transplantation, immunosuppressive therapy can result in an increased burden of HCV
viremia. Both patient and graft survivals are lower in HCV-positive compared to matched HCV-negative renal-transplant patients. Therefore, it is important to treat HCV
infection. At present, after
renal transplantation, there is no current safe and efficient
therapy.
Alpha-interferon (alpha-IFN) does not give a sustained virological response, and is associated with a high rate of
renal failure.
Ribavirin and
amantadine monotherapies are associated with a significant improvement in liver
enzymes, but have no impact upon HCV
viremia.
Ribavirin, however, may be indicated in cases of HCV-related glomerulopathy because it can significantly decrease
proteinuria. The combined use of alpha-IFN and
ribavirin should only be given to those patients who have developed posttransplant fibrosing cholestatic
hepatitis. Therefore, HCV
infection needs to be treated pretransplant. In dialysis patients, the only recommended
therapy, as yet, is alpha-IFN monotherapy. Pegylated alpha-IFN is under evaluation and
ribavirin is contraindicated because it results in severe
hemolytic anemia. Twelve months of alpha-IFN
therapy results in sustained virological clearance in approximately 40% of patients, regardless of their genotype. HCV
RNA, after three months of alpha-IFN
therapy, is a predictive factor for a long-term sustained response. Finally, when HCV-positive dialysis patients with a sustained virological response undergo successful
renal transplantation, very few suffer a virological relapse, thus emphasizing that these patients were cured.