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HCV-Associated Renal Diseases after Liver Transplantation

Over the last decade, evidence has accumulated that hepatitis C virus (HCV) infection is associated with glomerular diseases in native kidneys, with or without mixed cryoglobulinemia (1-2). Similar extrahepatic syndromes associated with HCV can occur after organ transplantation (3-4). It appears that HCV-infected renal transplant (RT) recipients may be prone to develop a spectrum of renal manifestations associated directly or indirectly with HCV infection. Membranoproliferative glomerulonephritis with or without mixed cryoglobulinemia (5-7), membranous nephropathy (8), acute or chronic transplant glomerulopathy (9-10), and acute renal thrombotic microangiopathy (11) have been reported in HCV-infected RT recipients. HCV infection has been causally or circumstantially associated with these pathologic entities (12) and work is in progress to identify the potential strategies to prevent some of these renal syndromes after RT. The association of HCV infection with renal disease in liver transplant (LT) recipients has been less fully characterized. A number of studies have reported HCVassociated glomerular diseases with nephrotic syndrome and cryoglobulinemia after LT (13-22). Successful LT can be associated with end-stage renal disease (ESRD) in up to 5% of recipients who are followed beyond 5 years (23). The number of patients described is small but the exact prevalence and clinical characteristics of these complications have not been well defined. The aim of this report is to review the available information regarding HCV-associated glomerular diseases and treatment approaches after LT. Hepatitis C infection and LT