The Argument for Transplantation
Hepatitis C in Renal Disease, Hemodialysis and TransplantationThis flow traces the tension between inferior posttransplant outcomes and the survival advantage of leaving dialysis.
increasing
Bearing strength in each event
decreasing
Inferior Recipient Outcomes

Inferior Recipient Outcomes
Persistent disadvantage
HCV-positive kidney recipients experience more liver disease, infection, diabetes, glomerulonephritis, and sometimes graft loss. Long follow-up reveals harms that short studies miss.
The argument against complacency
Transplantation does not erase HCV. It relocates the disease into an immunosuppressed body where complications may become more complex.
Dialysis Comparison

Dialysis Comparison
The alternative is also dangerous
Remaining on dialysis carries substantial mortality, cardiovascular burden, and ongoing HCV exposure. The absence of transplantation is not a neutral condition.
Relative survival
Comparisons repeatedly show a posttransplant survival advantage after the early postoperative period. The decision must therefore be made against dialysis mortality, not against an idealized infection-free outcome.
Qualified Recommendation

Qualified Recommendation
Transplantation remains preferred
For patients without advanced liver injury, Kidney transplantation remains the treatment of choice. The benefit is conditional on careful selection, pretransplant staging, and posttransplant surveillance.
A mature resolution
The conflict resolves through comparative reasoning: risk is accepted because the alternative is worse. Medical success is defined as the best available path, not the absence of danger.
long-term after transplantation
during waiting-list follow-up
near the clinical conclusion