A New Clinical Paradigm for Hepatitis C End-Stage Renal Disease Patients: Balancing Viral Eradication and Early Kidney Transplantation

Sanjay Kulkarni, Albert Do, AnnMarie Liapakis


The development of safe and effective direct-acting antiviral (DAA) therapies for chronic hepatitis C virus (HCV) infection and more recent expansion of the therapy options with safety and efficacy in patients with severe chronic kidney disease (CKD), has changed the clinical paradigm for this subgroup of patients. The changing landscape and decision-making is particularly striking when balancing early kidney transplant with an HCV positive kidney allograft versus viral eradication. DAA therapy has allowed for revision of transplantation policy to expand acceptance criteria of HCV viremic severe CKD patients for kidney transplant alone, and also to consider utilization of grafts from HCV viremic donors. A variety of factors need to be considered in the care of these patients, including, accurate staging of liver disease, medication choice, timing of therapy in relation to kidney transplantation, and medication interactions. This clinical review provides an algorithm for the evaluation, triage, and treatment, of this population from the perspective of the hepatology and nephrology medical and transplant surgical subspecialties.

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DOI: http://dx.doi.org/10.18103/imr.v3i9.570


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