Hepatitis C virus (HCV) is a small single-stranded RNA virus that caus
es non-A, non-B hepatitis in over 90% of cases. Diagnosis of HCV infec
tion relies on detection of specific antibodies or the presence of vir
al nucleic acid, HCV is encountered worldwide and is transmitted by pa
renteral routes. The acute clinical presentation is usually symptomles
s but infection persists in more than 80% of infected patients leading
to cirrhosis in 20-30% of cases after 20 years from infection. Alpha
interferon is the only effective treatment for HCV chronic hepatitis,
inducing clearance of the virus in 10-20% of patients; however, there
have been no controlled trials of prevention of cirrhosis or hepatocel
lular carcinoma by therapy with interferon or other antiviral agents.
Patients with end-stage renal failure are at risk for HCV infection, A
complete screening for the detection of HCV in dialysis and kidney-tr
ansplanted patients should include the detection of anti-HCV antibodie
s by ELISA and of HCVR-NA in serum by PCR. The prevalence of anti-HCV
antibodies in hemodialysis and kidney-transplanted patients reflects t
hat observed in the general population, with a definite North to South
gradient. ALT increases are usually of low grade and intermittent in
dialyzed patients with HCV infection and GGT seems to be a more stable
and useful sign of liver disfunction. Prevalence of HCV infection is
significantly higher in hemodialysis than in peritoneal dialysis patie
nts; moreover, patient to patient infection for HCV has been proved in
hemodialysis units but not in peritoneal dialysis or home hemodialysi
s: blood transfusions and manipulation of blood-contaminated material
are the main reasons for these differences. The liver lesions observed
in dialysis patients were comparable to those in anti-HCV-positive bl
ood donors, Cirrhosis induced by HCV seems to cause death in less than
1% of dialyzed patients, but these figures could be very different in
patients who acquired HCV in their youth. Preliminary results from pi
lot studies have shown the effectiveness of interferon in dialyzed pat
ients with HCV infection. However the cost-benefit ratio and efficacy
of interferon therapy should be evaluated in randomized controlled tri
als with an adequate sample size. HCV infection in kidney transplant r
ecipients is acquired before or at the moment of transplantation becau
se of HCV infection in the donor. The question about transplanting HCV
-infected organs even in HCV-infected recipients is still unanswered.
HCV infection is usually clinically silent during the first years afte
r transplantation and does not seem to affect either patient or graft
survival in the first 10-15 years. Treatment with interferon should be
avoided in kidney transplant recipients because of the high frequency
of rejection.