Kesiraju Sailaja, Srikanti Praneeth, Sahariah S
Transimmun- Transplantation Immunology and Research Centre, Somajiguda, Hyderabad, Andhra Pradesh 500082 India.
Department of Immunology, Bhagwan Mahavir Medical Research Centre, Hyderabad, India.
Virusdisease. 2017 Sep;28(3):233-241. doi: 10.1007/s13337-017-0393-5. Epub 2017 Aug 24.
Prevalence of hepatitis C infection, which is associated with mortality and morbidity, is higher in chronic kidney disease patients on hemodialysis and transplant recipients when compared to non HCV infected patients. In addition to the conventional risk factors, HCV infection maybe an additional risk factor in the development of chronic kidney disease. HCV causes adverse effects leading to the poor long term outcome in renal transplant recipients; hepatitis C infection can cause both hepatic as well as extra hepatic complications. Prior evaluation and management of HCV infection is recommended for better long term outcome as there are chances of higher rejection rates with HCV treatment. However transplantation is not contraindicated in those patients who cannot be treated prior to the transplantation as patient survival is better when compared to dialysis patients. Kidney Disease Outcome Quality Initiative Clinical Practice Guidelines recommend interferon based therapy only when there is a rapid worsening of HCV related hepatic injury in transplant recipients. HCV treatment has been improved by the addition of direct acting antiviral, protease inhibitors and polymerase inhibitors. Combination therapies are showing improved sustained virological response rates. NS3-4A protease inhibitors, nucleotidic/nucleosidic NS5A and NS5B polymerase inhibitors are promising treatments which are under trials with different combinations. The focus of this review is to evaluate and optimize the treatment options of co-existing HCV infection in renal transplant recipients and discuss more promising alternative treatment regimen.
与死亡率和发病率相关的丙型肝炎感染在接受血液透析的慢性肾病患者和移植受者中比未感染丙型肝炎病毒（HCV）的患者更为普遍。除了传统的危险因素外，HCV感染可能是慢性肾病发展中的一个额外危险因素。HCV会导致不良影响，从而使肾移植受者的长期预后不佳；丙型肝炎感染可引起肝脏和肝外并发症。由于HCV治疗有更高的排斥率风险，因此建议对HCV感染进行预先评估和管理，以获得更好的长期预后。然而，对于那些在移植前无法接受治疗的患者，移植并非禁忌，因为与透析患者相比，这些患者的生存率更高。肾脏病预后质量倡议临床实践指南建议，仅在移植受者中HCV相关肝损伤迅速恶化时才采用基于干扰素的治疗。通过添加直接作用抗病毒药物、蛋白酶抑制剂和聚合酶抑制剂，HCV治疗得到了改善。联合疗法显示出持续病毒学应答率有所提高。NS3-4A蛋白酶抑制剂、核苷酸/核苷类NS5A和NS5B聚合酶抑制剂是有前景的治疗方法，目前正在进行不同组合的试验。本综述的重点是评估和优化肾移植受者中并存的HCV感染的治疗选择，并讨论更有前景的替代治疗方案。
