Mini-ReviewsThe Kidney Transplant Recipient with Hepatitis C Infection Pre- and Posttransplantation TreatmentTerrault, Norah A.; Adey, Deborah B. Author Information *Department of Medicine, Division of Gastroenterology, and †Department of Medicine, Division of Nephrology, University of California, San Francisco, San Francisco, California Address correspondence to: Dr. Norah Terrault, S357, 513 Parnassus Avenue, San Francisco, CA 94143-0538. Phone: 415-476-2227; Fax: 415-476-0659; E-mail: [email protected] Clinical Journal of the American Society of Nephrology 2(3):p 563-575, May 2007. | DOI: 10.2215/CJN.02930806 Buy Metrics Abstract Liver disease secondary to chronic hepatitis C virus (HCV) infection is an important cause of morbidity and mortality in dialysis patients and kidney transplant recipients. Evaluation of patients with chronic HCV infection is warranted to determine stage of disease and the need for HCV therapy. Although combination therapy with interferon (IFN) plus ribavirin is the standard of care for chronic HCV infection, IFN monotherapy is recommended in dialysis patients because ribavirin is contraindicated in the presence of renal failure. The goals of pretransplantation HCV therapy are to decrease the risk for progression of HCV-associated liver disease, stabilize renal function in patients with HCV-related glomerulopathy, and prevent development of HCV-associated renal disease after transplantation. Posttransplantation HCV therapy is generally not recommended because of concerns regarding risk for precipitating acute rejection; however, antiviral therapy may be indicated to treat HCV-related glomerulopathy or prevent progression of chronic hepatitis C in patients with more advanced stages of fibrosis. When treatment is required, restored renal function allows use of combination therapy with IFN and ribavirin. Limitations of current HCV therapy include lack of tolerability and suboptimal response rates. New antiviral agents that can be used in dialysis patients (e.g., ribavirin alternatives) and in the posttransplantation setting (e.g., IFN alternatives) are needed to improve outcomes in these populations. Copyright © 2007 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.