Some people living with hepatitis C can receive a kidney transplant if their kidneys fail. These individuals can also donate a kidney if they are otherwise healthy and a doctor agrees that it is appropriate.

Globally, an estimated 58 million people live with chronic hepatitis C. Each year, about 290,000 people die from the condition.

Although most fatalities from hepatitis C are due to cirrhosis and liver cancer, doctors recognize that infection with the hepatitis C virus (HCV) is also a potential cause of kidney injury and chronic kidney disease. A kidney transplant can help improve the length and quality of a person’s life.

This article looks at hepatitis C and kidney transplants, including how HCV affects the kidneys, whether people with hepatitis C can donate a kidney, and the effects of the donation procedure.

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HCV causes hepatitis C, which primarily affects the liver. However, in some cases, the virus can also affect the kidneys.

A 2015 study of 100,518 United States veterans with hepatitis C found a link between the condition and:

  • higher incidences of decreased kidney function
  • progressive loss of kidney function
  • higher risk of death

Acute kidney injury

Although it is not common, HCV can lead to acute kidney injury. This occurs when the kidneys suddenly become damaged. It can happen if HCV causes vasculitis, which is the swelling of the blood vessels, arteries, and veins.

In rare cases, the medications that nephrologists use to treat hepatitis C can also increase the chance of acute kidney injury. However, if a person gets treatment quickly, the condition usually resolves, and the kidneys begin working again.

Chronic kidney disease

Occasionally, HCV can also lead to chronic kidney disease, which causes long-term damage to the kidneys and often deteriorates over time. This can happen for several reasons.

HCV can cause a condition called glomerulonephritis, in which the tiny filters in the kidneys, or glomeruli, become inflamed and swollen. This inflammation causes irreversible damage.

People with hepatitis C also have a higher risk of developing diabetes, which is the leading cause of kidney disease and failure.

It is possible for individuals with HCV to donate healthy kidneys, either during their lifetime or after they die. However, it depends on the health of their kidneys.

Previously, people with HCV could not donate kidneys, but this has changed with the availability of direct-acting antiviral (DAA) drugs. These drugs offer cure rates above 95% for people who have contracted the virus and also have chronic kidney disease or end stage renal disease.

There is a high demand for organ donors in the U.S., so a doctor may recommend using a healthy kidney from an HCV-positive donor and then treating the recipient with DAAs after the transplant surgery.

Some evidence indicates that HCV-positive individuals who receive kidneys from HCV-positive donors have slightly worse outcomes than people who receive a kidney from HCV-negative donors. However, they have a shorter waiting time, which can be lifesaving.

People with HCV are not eligible for kidney donation if they have any kidney damage or disease.

Individuals living with hepatitis C can receive a kidney transplant, but a medical team will need to consider the risks and benefits of the procedure.

For example, if a person with hepatitis C has significant liver damage, it may be unsafe for them to undergo transplant surgery. However, if they can receive a liver and kidney transplant at the same time, this may make receiving a new kidney possible.

Before individuals can undergo a kidney transplant procedure, they must find a suitable donor who fits their specific health criteria. A donor can be an individual who has recently died and stipulated their wish to donate a kidney, or it can be a living donor who wants to give a kidney to the person in need.

Following a doctor’s identification of a suitable donor, a kidney transplant from a live donor usually involves the following steps:

  1. A doctor will admit the recipient and donor to the hospital. Both will undergo tests, such as physical examinations, blood tests, and X-rays, to confirm their health and suitability.
  2. Medical staff will shave the chest and abdomen to remove any hair in preparation for the surgery. They will also insert IV lines.
  3. A doctor will administer a general anesthetic to put both people to sleep. They may also use a local anesthetic at the site where the surgeon will make their incision.
  4. A surgeon will make an incision in the donor’s abdomen, remove the kidney for donation, and close the wound.
  5. They will then make an incision in the recipient’s abdomen, through which they will place the donated kidney. They will attach essential blood vessels and the ureter to connect the kidney to the bladder.
  6. As they sew up the recipient, the surgeon may insert a small drain in the abdomen to remove excess fluid. This drain will remain in place for 10 days after surgery. A surgeon may also insert a catheter at this stage if one is not already in place. Catheters allow the bladder to empty.
  7. A medical team will closely monitor both individuals as they wake up and begin recovering. They will receive pain medication for a few days after surgery. The recipient of the donated kidney may undergo dialysis to remove any substances in the new kidney that the body might reject.

With donations from deceased individuals, the procedure for the recipient is much the same. Instead of taking the kidney from a live donor, doctors carefully chill and package a kidney from a recently deceased donor and transport it to the hospital.

People with hepatitis C who receive kidneys from HCV-negative donors can take DAAs to treat the infection while they are waiting for surgery. People who have an HCV-positive donor may get their transplant sooner, so they will take DAAs after the surgery.

All people who receive a kidney transplant will have to take anti-rejection drugs for the rest of their lives. These stop the body from rejecting the donated kidney.

Evidence suggests that in the general population, people who donate a kidney can live a regular life with their one remaining kidney, although there is a long-term risk of slightly high blood pressure.

When doctors remove one kidney, the remaining kidney compensates by increasing its blood-filtering capacity. People should experience a return of total kidney function to about 70% within 10 or 11 days of donating a kidney. In general, kidney donation may reduce someone’s life expectancy by 0.5–1 year.

There is little research on how donating a kidney affects HCV-positive people. Often, HCV-positive kidney donors are deceased individuals who have requested that doctors use their organs in transplant procedures.

If an individual is HCV-positive and wishes to donate a kidney during their lifetime, they should discuss it with their doctor. As chronic HCV can damage the kidneys, it may not be advisable to donate one due to the risk of this complication developing later on.

In most cases, kidney transplantation significantly improves an individual’s quality of life. A person who receives a new kidney may no longer require dialysis and can return to a more normal life.

However, kidney transplantation is not a cure for chronic kidney disease, and the individual must take medications for the rest of their life. As a result, they may still experience some physical and mental health challenges.

A person’s HCV status may also affect their life expectancy following a transplant. In an earlier 2010 study, doctors found that HCV-positive people have a 5-year survival rate of 77% following a transplant compared with 90% of HCV-negative patients.

However, this survival rate in transplant recipients with HCV is far better than in those who remain on dialysis.

HCV mainly affects the liver, but it can sometimes damage the kidneys too. In some cases, people with HCV may require a kidney transplant. If they are otherwise healthy, they may be eligible for the procedure. Doctors can then treat the infection before or after surgery.

Some people with HCV may wish to donate one of their kidneys to someone else. In some cases, this is possible during their lifetime. Alternatively, people can sign up to be organ donors when they die.

Read this article in Spanish.