Home Page

Introduction

You are being asked to consider whether or not you would accept a kidney transplant from a Hepatitis C virus infected donor.

The information in this leaflet will help you decide whether or not you would accept a kidney transplant from a donor who has had Hepatitis C.

What is Hepatitis C?

Hepatitis C is a virus that is transmitted in infected blood. It lives in the liver and blood of infected individuals and can cause inflammation and scarring of the liver. The scarring can be severe, although on average it takes thirty years for the scarring to become life threatening in non-transplant patients. Severe scarring may develop more rapidly in transplant patients taking drugs that suppress the immune system.

Treatments for Hepatitis C have changed greatly over recent years. It is now possible to cure nearly all patients who are infected with the Hepatitis C virus. Treatment requires taking tablets for eight to twelve weeks. Once the virus is cleared it does not come back and does not affect your long-term health.

Why am I being offered a Hepatitis C infected kidney transplant?

There are not enough donated organs in the UK to transplant into all people who may need them.

Due to recent breakthroughs in Hepatitis C virus treatment, it is now possible to consider using organs from donors infected with Hepatitis C virus for transplantation. These donors are generally younger than average and may be healthier, with lower blood pressure and less heart disease and other medical conditions.

Hence their donated organs may be of higher quality than average.

What are the risks to me if I receive a Hepatitis C infected kidney transplant?

The main risk of accepting a kidney transplant from a Hepatitis C virus infected donor is that you become infected with the virus yourself. You will be referred to hepatology specialists who will treat the Hepatitis C infection within a couple of weeks of your diagnosis. This will minimise the risk of any damage to you.

If Hepatitis C virus infection is not treated, you may become jaundiced (yellow) and may develop severe inflammation in the liver (called Fulminant cholestatic Hepatitis). In the longer term (3-6 months) Hepatitis C may result in kidney injury.

There is a very small chance that the Hepatitis C virus may not disappear after the eight to twelve weeks of treatment (see below). The chances of this happening are less than 2 in 100 (2%). If this were to happen, you would be offered a different course of tablets that has been shown to be highly effective in curing patients whose treatment has failed with other drugs.

These drugs achieve 96 to 98% cure rates. This means that it is very unlikely (1 chance in 2,500) that the transplant team will not be able to cure you of the virus if you are infected. Please discuss with your transplant doctor or surgeon if you have any further questions regarding this small chance that you would not be cured by the treatment.

Whilst all donors are routinely screened for the presence of other infections like HIV or Hepatitis B in addition to Hepatitis C, the screening tests can very rarely miss infections and there remains a very small possibility that these or other infections could also be transmitted at the time of transplantation.

What has happened to other patients who have been infected with Hepatitis C at the time of an organ transplant?

There have already been several studies looking at the results of transplanting kidneys from Hepatitis C virus infected donors into patients who are not infected with Hepatitis C virus. These have mainly taken place in the United States and patients have received treatment for Hepatitis C within four weeks of the transplant. In these studies, every recipient was cured of Hepatitis C. Importantly, the transplanted kidneys then went on to work very well, and the overall outcomes were the same for the patients who received kidneys from Hepatitis C virus infected donors as those for patients who received kidneys from Hepatitis C virus negative donors.

How do I know that the kidney from the Hepatitis C infected Donor has not been damaged by the virus?

Hepatitis C can, in rare cases, cause kidney damage. The health of kidneys that are offered for transplantation is carefully assessed by a series of blood and urine tests that are carried out on the donor before and after they die. Only kidneys with very little or no known pre-existing damage are used for transplantation. The same precautions will apply to kidneys from Hepatitis C virus infected donors.

Are there any risks to my family if I receive a Hepatitis C Infected kidney transplant?

The risks to your family are very small. Transmission of the virus is mainly through infected blood. Until you are cured of Hepatitis C virus, which should happen within the first three to four months after the transplant (includes length of Hepatitis C treatment); we recommend that you do not share your toothbrush and razor blades with anyone. The virus is not transmitted through kissing and saliva. The virus can be transmitted through sexual intercourse, although it is rare, so we recommend that you or your partner uses barrier contraception (condoms) until you are told that you have been cured of the virus.

How will I be treated if I receive a Hepatitis C infected kidney transplant?

After your transplant you will have a specific and very sensitive blood test to look for the presence of Hepatitis C virus in your blood. The first blood sample will be taken within the first seven days of your transplant, then again within the first fourteen days, at six weeks and the last sample will be taken at three months after your transplant. If all the virus tests are negative, then your transplant organ has not passed on the infection to you.

If any of these tests are positive for the Hepatitis C virus the hepatology specialised team will start you on highly effective treatment very soon after we receive the result. This means that you will be prescribed some specific antiviral tablets that you will need to take for a total of eight to twelve weeks. This will consist of either one extra tablet or three extra tablets a day. The exact number will depend on what treatment the doctors think is best suited to you. During treatment you will have regular blood tests to make sure that the treatment is working, and that the virus is disappearing from your blood. Once the treatment is finished you will have further blood tests to check that you have been cured of the virus. If the virus disappears from your blood and cannot be detected twelve weeks after the treatment has stopped then you have been cured. It is worth mentioning that these new drugs for Hepatitis C have very few side effects and are extremely well tolerated.