Hepatitis C and the Renal Transplant Patient

Summary Our understanding of HCV is evolving rapidly. The question of the risk of transmission within HD units is still unsettled, and definitive recommendations about isolating HCV‐infected patients are not possible. Although RT does not appear to be deleterious in many HCV‐infected patients, histologic and clinical evidence of severe liver disease should be a contraindication to RT (Fig. 2). To assess the ultimate effect of RT in patients with HCV, longer‐term studies are required. The role of different viral genotypes in the outcome of HCV infection in RT recipients requires further investigation. Pending more conclusive results, use of organs from anti‐HCV‐positive donors, even when transplanted into anti‐HCV‐positive recipients, is best avoided. The role of antiviral agents in RT recipients also remains to be defined, but preliminary results with alpha‐interferon have been disappointing, showing limited efficacy and possibly inducing allograft dysfunction. Clearly, the distinction between viral and host factors in the evolution and severity of HCV infection remains the most fundamental issue in understanding the pathobiology of this disease and developing appropriate guidelines for management in the renal transplant patient.