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Is it safe to undergo kidney transplant during Hepatitis C infection?

Q: My father is 60 years old and has developed a kidney problem and also got Hepatitis C during prostrate operation 7 years ago. His creatinine used to remain between 3-4 till the last 2 months. After that he suddenly collapsed and was detected to have blood infection. His kidney function worsened with creatinine shooting up to 9. His blood infection has been treated in CMC Vellore. He is on haemodialysis thrice a week. His liver also shows some scarring and the viral load is 65000 viral copies per ml. Doctors are planning for a kidney transplant. Will it be safe for him?

A:Kidney transplantation is certainly a better option as a form of renal replacement therapy as compared to dialysis, since it offers a better long-term outcome including a better quality of life, lower morbidity and mortality. Based on the information provided, your father doesn't seem to have any contra-indication for undergoing kidney transplantation (this includes his chronic Hepatitis C status). However, there are conflicting data on the long-term effects of Hepatitis C on the post-transplant liver function with some reports pointing towards significantly increased risk for liver disease. In spite of this, the long-term beneficial effect of kidney transplant outweighs whatever adverse effect the (kidney) transplantation may have on the course of the Hepatitis C infection. In the above scenario, it is advisable at first to consider Interferon-alfa therapy (a costly but safe treatment) for Hepatitis C infection prior to the kidney transplantation, since it is known to reduce the chances of liver disease after the transplant. Second, consider a liver biopsy to look for any histological/pathological evidence of liver disease arising out of the Hepatitis C infection. If there is a histological evidence of liver disease, one has to be cautious about the possible consequence of going ahead with the transplant since the exposure to the immuno-suppressive medications (given upon receiving the kidney transplant) could allow the Hepatitis virus to multiply and possibly worsen the liver disease.

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