ABSTRACT
Liver disease is an important complication after renal transplantation and Hepatitis C virus (HCV) infection is the most frequent cause of liver disease. Clinical course is irrelevant in the short-term, excepting rare cases of fibrosing cholestatic hepatitis. However, in the long run, HCV infection can lead to important liver complications such as cirrhosis, hepatocarcinoma and death. Because Interferon is contraindicated in renal transplant patients, the best way is to treat these patients in dialysis before transplantation. Interferon monotherapy is recommended because Ribavirin induces haemolytic anaemia. Most of the patients with sustained virological response re main HCV RNA negative after transplantation. HCV positive renal transplant patients have a higher risk for developing proteinuria, chronic rejection, infections and posttransplant diabetes. Long-term patient and graft survival rates are lower in HCV-positive patients than in HCV-negative graft recipients. Mortality is higher, mainly as a result of liver disease and infections. Notably, HCV infection is an independent risk factor for graft loss and the presence of posttrans plant diabetes and HCV-related glomerulonephritis can contribute to graft failure. Despite this, transplantation is the best option for the HCV-positive patient with end-stage renal disease. Finally, several measures after transplantation to minimize the consequences of HCV infection should be recommended. Adjustment of immunosuppres sion and careful follow-up in the outpatient clinic for early detection of proteinuria, renal insufficiency, infection, diabetes or worsening of liver disease are mandatory.
