Hepatitis C virus and kidney transplantation: Recent trends and paradigm shifts

The management of HCV infection in kidney transplantation presents significant challenges. HCV, left untreated, worsens patient and graft survival after kidney transplantation through multiple mechanisms. The field has evolved significantly in recent years, due to the ability to effectively eliminate the virus with direct-acting antivirals. Limited data suggest that current HCV treatment improves outcomes of infected kidney transplant patients. Along with the ability to successfully treat HCV, the increased HCV prevalence among donors has led to transplantation of kidneys from HCV-viremic donors into uninfected recipients. The practice has become increasingly common, but optimization of protocols to guide this practice is currently under debate. We have searched the literature on HCV and kidney transplantation, and review here the epidemiology, clinical outcomes, HCV treatment, and studies on transplantation from positive donor to negative recipient. We also discuss the evolving clinical management paradigms and address unresolved questions, highlighting the need for additional data with longer follow up.