Hepatitis C is a viral infection that causes liver damage. It’s spread through contaminated blood, for example, if you inject drugs with a needle that was used by someone with the virus.
It doesn’t typically cause symptoms right away, so it’s hard to know if you have it. Over time, though, the hepatitis C virus (HCV) can start to affect your liver function, leading to symptoms like fatigue and jaundice.
The main complications of an untreated infection are liver scarring (cirrhosis), liver cancer, and liver failure. But complications can also damage the kidneys, putting you at an increased risk of kidney disease and failure.
Although HCV poses additional risks during kidney transplants, new and emerging treatments have changed the landscape for potential donors and recipients. This article explores how hepatitis C affects eligibility for a kidney transplant.
Yes, it’s possible to receive a kidney transplant if you have hepatitis C. Being HCV-positive shouldn’t affect your eligibility. With that said, not everyone who has HCV is a good candidate for transplantation and it can be difficult to procure a donor kidney.
Your healthcare team will conduct extensive tests before recommending a transplant. If you’re HCV-positive, they’ll pay extra attention to your liver health. If you have complications, such as cirrhosis or liver cancer, you might not be healthy enough to undergo a kidney transplant.
On the other hand, if your liver is compromised but you’re otherwise healthy, your healthcare team might consider doing a liver transplant alongside your kidney transplant. This option can involve a longer wait, though, as it requires two donor organs.
If you’re recommended for a transplant, a friend or family member might be able to donate one of their kidneys to you. Otherwise, you’ll be placed on the Organ Procurement and Transplantation Network (OPTN) waiting list for a kidney from a recently deceased person.
You might have to wait more than 5 years. If you’re HCV-positive, you could potentially receive a transplant faster by accepting a kidney from an HCV-positive donor.
Not so long ago, accepting a kidney from someone with HCV was associated with a decreased chance of survival. But in 2014, a
Direct-acting antivirals (DAAs) can now eradicate the virus in most people. This is known as a sustained virologic response (SVR), and it means that the virus is no longer detectable in your body after a certain amount of time.
DAAs have similarly been used to treat HCV infections following kidney transplants from donors with the virus. There’s now a growing body of research evaluating the safety of this procedure, and the results are promising.
For example, a 2020 study of 379 people reported comparable 1-year survival rates among those who received a kidney from an HCV-positive donor and those who received a kidney from an HCV-negative donor.
Furthermore, the authors recommended making HCV-positive kidney transplants standard practice for everyone, which could significantly decrease recipient wait times.
Another advantage to accepting a kidney from an HCV-positive donor is that it might actually be healthier than a kidney from an HCV-negative donor. According to a 2020 article, deceased kidney donors with HCV are often younger than the average deceased kidney donor.
There are risks, of course. DAAs can cause side effects, and may not be available or affordable. Certain forms of HCV may be more aggressive, and exposure to the virus could weaken your immune system, making you vulnerable to other illnesses.
It’s important to weigh the risks and benefits of receiving a kidney from an HCV-positive donor with your healthcare team.
In the past, having hepatitis made it impossible to donate a kidney. Now that HCV is curable, recommendations are changing.
Whether you can donate will likely come down to your overall health, and the health of your kidney. If your HCV was left untreated for a long time, your kidneys might be damaged.
Your healthcare team will conduct tests to determine if you’re healthy enough to donate a kidney. If you’re currently HCV-positive, your doctor might recommend treating the infection with DAAs prior to the transplant surgery to eradicate the virus.
You should ask your doctor whether previously having HCV increases the risk of complications after donating your kidney.
Getting a new kidney is major surgery, regardless of whether you have HCV. You’ll be under general anesthesia for the whole procedure, which typically lasts 3 or 4 hours.
During the transplant, your surgeon will make an incision in your abdomen and insert the donor kidney. Then the surgeon will attach it to the blood vessels and the ureter so that it can start working. Your original kidneys will be left in your body unless they’re causing issues.
For donors or recipients with HCV, the transplantation process includes treatment with DAAs either before or after the surgery.
- If you’re HCV-negative: If your donor is alive, they’ll be treated for HCV before the transplant. You’ll be treated for HCV after the transplant.
- If you’re HCV-positive: If your donor is HCV-negative, you’ll be treated before the transplant. If your donor is HCV-positive, you’ll be treated for HCV after the transplant.
Kidney disease can progress to the point that the kidneys can no longer effectively filter waste from the bloodstream. This is known as end-stage kidney disease or kidney failure, and it’s the reason for a kidney transplant.
A transplant isn’t a cure, but a donor kidney can function as well as a healthy kidney and improve your overall quality of life. It comes with significant challenges and risks, though.
When a transplant isn’t recommended, dialysis is another option. Although there are several types of dialysis, hemodialysis is the most common. It involves the use of a machine outside the body (hemodialyzer) to filter the blood.
Dialysis isn’t as effective as a kidney transplant. Although it can help improve your health by removing toxins from the bloodstream, it requires a significant time investment. You’ll have to do a 4-hour dialysis session either in your home or at a center or hospital at least three times per week.
Some people with end-stage kidney disease opt to forgo both transplants and dialysis. This is known as conservative management, and it focuses on relieving your symptoms and maintaining your quality of life for as long as possible.
Hepatitis C infection causes chronic inflammation that can damage the kidneys in the long term. Most of the time, it affects the tiny blood vessels (capillaries) of the glomerulus, a net-like unit that filters toxins from the bloodstream. There are around 1 million glomeruli in each kidney.
Kidney-related complications in people with HCV are well documented. According to a
People with hepatitis C who undergo kidney dialysis are at an increased risk of death from heart or liver failure. HCV also presents risks in kidney transplants.
Until very recently, it wasn’t possible to donate a kidney if you had HCV. As a result, there’s relatively little research evaluating the long-term outlook for living kidney donors who are HCV-positive.
With that said, your physicians would not have approved you to do the transplant if it weren’t possible for you to lead a healthy life with only one kidney. In addition, if you were medically cleared to donate your kidney, your HCV was likely treated and cured.
Keep in mind that although your HCV was cured, the damage it caused to your liver will remain. In addition, it’s possible to get HCV again. A new HCV infection will require another course of treatment.
After your transplant, you’ll spend up to a week in the hospital being monitored by your healthcare team. Once you go home, you can expect frequent appointments and blood tests to ensure your new kidney is functioning as it should and your body has accepted the graft. Other tests will measure the amount of HCV in your bloodstream.
It’s critical that you follow your doctor’s instructions carefully following the transplant. You’ll be required to take medication to ensure your immune system doesn’t attack the new kidney. You’ll also have to take DAAs for several weeks to clear the HCV.
Although research is ongoing, 2020 studies published in the American Journal of Kidney Diseases and Transplantation, along with a 2021 study from
In general, you can expect to return to your regular activities 2 to 3 months following the transplant.
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