Cohen-Bucay Abraham, Francis Jean M, Gordon Craig E
Renal Section, Boston University Medical Center, Boston, Massachusetts, USA.
Division of Nephrology and Transplant Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Hemodial Int. 2018 Apr;22 Suppl 1:S61-S70. doi: 10.1111/hdi.12643.
Hepatitis C virus (HCV) infection is prevalent in patients with kidney disease including transplant candidates and recipients. It is associated with increased morbidity and mortality in end-stage renal disease patients and also increases the risk of allograft rejection and decreases allograft and patient survival post-transplant. Newly developed direct acting antivirals have revolutionized the way HCV is treated. Whether patients are treated before or after kidney transplantation, the cure rates with direct acting antivirals are >90%. Great debate has formed revolving the optimal timing to treat kidney transplant candidates. On the one hand, treatment before transplantation decreases early post-transplant complications related to HCV. On the other, postponing treatment until after transplantation opens the possibility of transplanting a kidney from a HCV positive donor, which is associated with shorter waiting time and improved organ utilization by expanding the organ donor pool. Most patients living in an area where waiting time is reduced by accepting an HCV positive kidney would benefit by the strategy of treatment post-transplantation, but this decision needs to be individualized in a patient-by-patient basis given that there are special circumstances (i.e., severe HCV-related extrahepatic manifestations, availability of live donors, etc.) in which treatment before transplant might be preferred.
丙型肝炎病毒（HCV）感染在包括移植候选者和接受者在内的肾病患者中普遍存在。它与终末期肾病患者发病率和死亡率的增加相关，还会增加同种异体移植排斥反应的风险，并降低移植后同种异体移植物和患者的存活率。新开发的直接作用抗病毒药物彻底改变了HCV的治疗方式。无论患者在肾移植前还是移植后接受治疗，直接作用抗病毒药物的治愈率均>90%。关于治疗肾移植候选者的最佳时机已形成了激烈的争论。一方面，移植前治疗可减少与HCV相关的移植后早期并发症。另一方面，将治疗推迟到移植后则有可能移植来自HCV阳性供体的肾脏，这与缩短等待时间以及通过扩大器官供体库提高器官利用率相关。大多数生活在通过接受HCV阳性肾脏可缩短等待时间地区的患者，将从移植后治疗策略中受益，但鉴于存在特殊情况（即严重的HCV相关肝外表现、活体供体的可用性等），在这些情况下可能更倾向于移植前治疗，因此这一决定需要逐案个体化。
