Tang Ignatius Y S, Walzer Natasha, Aggarwal Nidhi, Tzvetanov Ivo, Cotler Scott, Benedetti Enrico
Section of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
Int J Nephrol. 2011;2011:245823. doi: 10.4061/2011/245823. Epub 2011 Apr 26.
Chronic Hepatitis C (HCV) infection is an important cause of morbidity and mortality in patients with end-stage renal disease. Renal transplantation confers a survival advantage in HCV-infected patients. Renal transplant candidates with serologic evidence of HCV infection should undergo a liver biopsy to assess for fibrosis and cirrhosis. Patients with Metavir fibrosis score ≤3 and compensated cirrhosis should be evaluated for interferon-based therapy. Achievement of sustained virological response (SVR) may reduce the risks for both posttransplantation hepatic and extrahepatic complications such as de novo or recurrent glomerulonephritis associated with HCV. Patients who cannot achieve SVR and have no live kidney donor may be considered for HCV-positive kidneys. Interferon should be avoided after kidney transplant except for treatment of life-threatening liver injury, such as fibrosing cholestatic hepatitis. Early detection, prevention, and treatment of complications due to chronic HCV infection may improve the outcomes of kidney transplant recipients with chronic HCV infection.
慢性丙型肝炎（HCV）感染是终末期肾病患者发病和死亡的重要原因。肾移植可使HCV感染患者获得生存优势。有HCV感染血清学证据的肾移植候选者应接受肝活检以评估纤维化和肝硬化情况。Metavir纤维化评分≤3且为代偿性肝硬化的患者应评估是否适合基于干扰素的治疗。实现持续病毒学应答（SVR）可能会降低移植后肝脏和肝外并发症的风险，如与HCV相关的新发或复发性肾小球肾炎。无法实现SVR且没有活体肾供体的患者可考虑使用HCV阳性肾脏。肾移植后应避免使用干扰素，除非用于治疗危及生命的肝损伤，如纤维化胆汁淤积性肝炎。对慢性HCV感染引起的并发症进行早期检测、预防和治疗可能会改善慢性HCV感染的肾移植受者的预后。
