HEPATITIS-C INFECTION IN RENAL-TRANSPLANT PATIENTS - NEW INSIGHTS ANDUNANSWERED QUESTIONS

The prevalence of HCV infection in a population of renal transplantati on patients is mostly dependent on that preexisting before transplanta tion, It also has been demonstrated that HCV infection can be transmit ted by the renal graft. Although grafting an HCV+ kidney does not affe ct survival 5 years after surgery, the risk incurred by recipients on the longer term is unclear. A suggestion has been made to reserve HCV kidneys for recipients who are themselves HCV+. However, it has been established that a given HCV strain has little chance of inducing immu nity to a different HCV strain. This is why the use of HCV+ kidneys no longer meets consensus. It could be considered to match the recipient and the graft with regard to the HCV strain when genotype identificat ion is routinely available, quick and reliable. Immunosuppressive ther apy enhances viral replication Its longterm effect on the course of HC V disease is unclear. In particular, no studies have compared the long -term outcome of HCV+ patients treated by haemodialysis and transplant ation. The data available on the 10-year outcome of HCV+ grafted patie nts are nonetheless reassuring. At least they allow considering renal transplantation to non-cirrhotic HCV+ patients. Several issues related to the interaction between HCV and immunosuppressive therapy remain t o be clarified. Does the viral strain play a role in the course of inf ection under immunosuppressive treatment? Does immunosuppressive treat ment promote strain mutagenesis? Does HCV infection require modulation of the immunosuppressive treatment?