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Arch Hellen Med, 30(5), September-October 2013, 574-586


Viral hepatitis in patients with kidney transplantation

V.A. Sevastianos,1 S.P. Dourakis2
1Fourth Department of Internal Medicine, "Evangelismos" General Hospital, Athens,
2Second Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Hippokration" General Hospital, Athens, Greece

Infection with HBV and HCV viruses is more frequent in patients on hemodialysis and those with kidney transplants than in the general population, and is associated with rapid progression of the resultant hepatitis to the more severe stages, with a significant effect on overall survival. Emergent infection with HEV virus has recently been added to causes of chronic liver disease, particularly among immunocompromised patients. Changes in the immune status of kidney transplant recipients during the first months following transplantation can result in reactivation of HBV infection (fulminant hepatitis) or in the restoration of immune system competence with subsequent a rapid clearance of the infected hepatocytes. Preemptive treatment with nucleos(t)ide analogues, regardless of HBV-DNA levels in the serum, could prevent the development of such complications in kidney graft recipients. Treatment of HCV infection in these patients is not routine, mainly due to the possibility of graft rejection associated with the administration of interferon (IFN). There are certain clinical circumstances, however, where the risk of treatment is outweighed by the potential advantage, which in some cases is significantly higher, such as recurrent HCV-associated glomerulonephritis. Early clinical awareness of viral hepatitis is essential and may result in significant benefits to patients with a renal transplant.

Key words: Hepatitis, Kidney transplantation, Natural history, Treatment.

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