Hepatitis C infection in renal transplant patients: new insights and unanswered questions.

The prevalence of HCV infection in a population of renal transplantation patients is mostly dependent on that preexisting before transplantation. It also has been demonstrated that HCV infection can be transmitted by the renal graft. Although grafting an HCV+ kidney does not affect survival 5 years after surgery, the risk incurred by recipients on the longer term is unclear. A suggestion has been made to reserve HCV+ kidneys for recipients who are themselves HCV+. However, it has been established that a given HCV strain has little chance of inducing immunity to a different HCV strain. This is why the use of HCV+ kidneys no longer meets consensus. It could be considered to match the recipient and the graft with regard to the HCV strain when genotype identification is routinely available, quick and reliable. Immunosuppressive therapy enhances viral replication. Its long-term effect on the course of HCV disease is unclear. In particular, no studies have compared the long-term outcome of HCV+ patients treated by haemodialysis and transplantation. The data available on the 10-year outcome of HCV+ grafted patients are nonetheless reassuring. At least they allow considering renal transplantation to non-cirrhotic HCV+ patients. Several issues related to the interaction between HCV and immunosuppressive therapy remain to be clarified. Does the viral strain play a role in the course of infection under immunosuppressive treatment? Does immunosuppressive treatment promote strain mutagenesis? Does HCV infection require modulation of the immunosuppressive treatment?