How does Hepatitis C infection affect kidney patients?
Dr Victor Lee talks about the damage that Hepatitis C infection can do to kidney transplant patients.
In light of heightened public attention on the issue of kidney transplant patients infected with hepatitis C, Dr Victor Lee Tswen Wen, a general surgeon who specialises in kidney transplants, and also the treatment of hepatitis C, shares with us the implications of such an infection on a kidney patient.
Hepatitis C is a virus infection that can lead to inflammation and damage to the liver. It is caused by the hepatitis C virus (HCV), which is generally considered the most serious in the hepatitis group of viruses. “The national blood bank and national organ transplant unit in Singapore routinely and robustly screens for possible HCV infection in donors,” says Dr Lee, who currently practises at Gleneagles Hospital, Singapore. “Thus, HCV infection in a transplant setting is a rarity in Singapore, barring major accidents or a serious breach in protocol.”
The problem of hepatitis C infection in transplant patients is made worse by how common diagnosis tests for hepatitis C are less effective in transplant patients. “Screening for HCV infection is generally performed using a test that detects antibodies reacting to the hepatitis C virus,” Dr Lee says. “However, in patients with weakened immune systems, such as transplant recipients, antibody production may be delayed or absent.”
Hepatitis C tends to be a slow-acting disease, but the condition can deteriorate rapidly in kidney transplant patients. “Some patients may experience accelerated fibrosis progression in the liver,” says Dr Lee. Liver fibrosis is the scarring and damage of the liver caused by liver diseases. When liver fibrosis is advanced, it can develop into liver cirrhosis, which can lead to liver failure and liver cancer. “There is data suggesting that fibrosis progression is faster if HCV infection is acquired during or after kidney transplantation, and hepatitis C-induced liver cirrhosis is associated with a high risk of liver cancer development.”
Hepatitis C not only affects the liver, it can cause complications for kidney transplant patients. “There is strong clinical data linking chronic HCV infection to acute kidney inflammation in transplanted kidneys,” Dr Lee says, “and it can cause transplant glomerulopathy, a disease of the transplanted kidney where there is a 40% to 70% chance of losing the kidney graft.” In addition, Dr Lee also explains that hepatitis C patients have a higher chance of getting diabetes, which is often the root cause that led to a kidney transplant.
Overall, studies in HCV-infected kidney transplant recipients found chronic HCV infection to be a risk factor that lowers the chances of a successful kidney transplant and lowers patient survival.
Kidney transplant patients who have been infected by the hepatitis C virus have to be treated very carefully. While hepatitis C treatment has improved in recent years, the standard treatment of hepatitis C is also dangerous to the kidney transplant patient as it contains a chemical compound that can increase the risk of rejection and failure of the new kidney. There is, however, a newer treatment for hepatitis C that does not contain this chemical compound, reducing the risk for kidney transplant patients.