Management of hepatitis B and C virus infection before and after renal transplantation

Purpose of review: The management of hepatitis B and C-related liver disease in patients with chronic kidney disease remains an area of controversy. The availability of novel antiviral agents has allowed the implementation of numerous trials concerning the treatment of hepatitis before and after renal transplantation. Recent findings: Long-term trials with lamivudine for chronic hepatitis B infections after renal transplantation have shown durable suppression of hepatitis B viraemia ranging between 43 and 78%; however, the 3-4 year cumulative probability of developing lamivudine resistance is approximately 60%. Lamivudine-resistant strains have led to hepatic decompensation in several renal transplant recipients. The sustained virological response rate after interferon monotherapy in dialysis patients with chronic hepatitis C is approximately 40%, but tolerance to interferon monotherapy is poor, and its use is contraindicted after renal transplantation because of acute graft dysfunction. Encouraging sustained virological responses have been obtained after combined therapy (interferon plus ribavarin) in dialysis patients, but the appropriate ribavirin dose remains to be assessed. Only preliminary information exists on the use of pegylated interferon in end-stage renal disease. Summary: This review summarizes recent and novel advances in the antiviral treatment of hepatitis B and C in dialysis patients and renal transplant recipients.