Treatment of hepatitis C in potential kidney and heart transplant patients

The recent availability of effective antiviral agents offers new options in the management of chronic hepatitis C in infected organ transplant candidates. The use of IFN after renal transplantation for HCV-infected recipients is complicated by the high rate of graft impairment. IFN monotherapy can lead to excellent results in selected patients on dialysis, with long-term remission being durable after RT. Preliminary data encourage the cautious use of combined therapy (IFN plus RBV) in dialysis populations. The use of PEGIFN monotherapy in dialysis patients is under evaluation. The frequency and outcome of HCV infection after orthotopic heart transplant remains poorly characterized. The limited information on antiviral therapy for HCV infection in orthotopic heart recipients suggests that IFN can be safely administered and is well tolerated. No data on antiviral therapy in heart transplant candidates exist. Large-scale trials are necessary to assess the optimal antiviral regimen. More data are needed on the role of liver biopsy in assessing the risk of organ transplant in cardiac and renal transplant candidates with HCV.