The Transplant Threshold
Hepatitis C in Renal Disease, Hemodialysis and TransplantationThis flow traces how Kidney transplantation becomes both the preferred renal replacement therapy and a new arena of HCV-related danger.
increasing
Bearing strength in each event
decreasing
Transplant Advantage

Transplant Advantage
Leaving dialysis
Despite HCV-related hazards, Kidney transplantation offers better survival than remaining on dialysis for suitable patients. The decision therefore balances infection against the mortality of prolonged End-stage renal disease.
Conditional hope
The benefit depends on excluding advanced liver injury and evaluating extrahepatic complications. Transplantation is not a cure for HCV, but it can change the odds of survival.
Pretransplant Staging

Pretransplant Staging
Hidden fibrosis
Many candidates have substantial fibrosis or cirrhosis despite mild symptoms and deceptively low aminotransferase levels. Liver biopsy remains the central method for determining whether kidney-alone transplantation is safe.
A fork in destiny
Compensated disease may permit kidney transplantation, while decompensated cirrhosis redirects the candidate toward Liver-kidney combined transplantation. The biopsy turns an invisible risk into a formal allocation decision.
Posttransplant Vulnerability

Posttransplant Vulnerability
Immunosuppression changes the terrain
Viral replication may rise after transplantation, while diabetes, infection, glomerulonephritis, rejection, and progressive liver disease threaten both graft and recipient. The new kidney introduces survival but also new biological pressure.
Continued preference
Long-term outcomes remain inferior to those of uninfected recipients, yet transplantation still generally outperforms dialysis. The result is a qualified victory requiring surveillance rather than a clean resolution.
before transplantation
during candidate evaluation
after Kidney transplantation