Management of hepatitis C in a patient undergoing solid organ (kidney) transplant

Abstract

Many patients with hepatitis C (HCV) suffer from concurrent renal disease requiring dialysis and eventual renal transplant. HCV treatment with direct-acting antivirals (DAA) is safe and effective in the context of renal transplant, but the optimal timing of treatment in proximity to transplant remains a focus of debate. We present the case of a 60-year-old male with HCV genotype 3 infection. He failed two prior interferon-based treatments, underwent previous separate liver and kidney transplants, and is currently under evaluation for a second kidney transplant for end-stage renal disease (ESRD). Using this illustrative case, we discuss topics pertinent to the evaluation and clinical care of HCV-infected renal transplant candidates including evaluation for a simultaneous liver-kidney transplant in the context of HCV infection, optimal timing of HCV treatment with respect to transplantation, and the safety and monitoring requirements during DAA treatment in renal transplant candidates.