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Presenter: Nassim, Kamar, Toulouse, France
Hepatitis C virus (HCV) infection is known to have a harmful effect after kidney transplantation. Patients’ survival is significantly reduced in HCV-positive RNA-positive kidney-transplant patients compared to those not infected by HCV. Increased risk of death in HCV-infected patients is related to sepsis, post-transplant diabetes mellitus, cardiovascular disease, and liver disease. HCV infection was responsible for progressive liver fibrosis in a subgroup of kidney-transplant patients and cases of hepatocellular carcinoma have been reported. Grafts’ survival is also significantly reduced in HCV-positive RNA-positive kidney-transplant patients compared to those not infected by HCV. Until now, there has been no efficient and safe therapy to eliminate HCV infection after kidney transplantation. Interferon-based anti-HCV therapy is relatively contraindicated in the setting of kidney transplantation because of the increased risk of acute rejection. Hence, it was recommended to treat all HCV-positive RNA-positive candidates for kidney transplantation after transplantation. However, since new-generation direct anti-viral agents (DAAs) were shown to be highly efficient for treating HCV infection in patients with impaired kidney function (including dialysis patients) and after kidney transplantation, nowadays the choice for treating candidates for kidney transplantation before or after transplantation depends on several factors: HCV genotype, living or deceased donor, high rate of HCV-positive donors… The different strategies will be discussed.
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