{"id":2903,"date":"2026-09-06T16:13:54","date_gmt":"2026-09-06T16:13:54","guid":{"rendered":"https:\/\/bookinghospital.org\/?p=2903"},"modified":"2026-09-06T16:41:31","modified_gmt":"2026-09-06T16:41:31","slug":"hepatitis-b-or-c-and-kidney-transplant","status":"publish","type":"post","link":"https:\/\/bookinghospital.org\/az\/hepatitis-b-or-c-and-kidney-transplant\/","title":{"rendered":"Hepatitis B or C and Kidney Transplant"},"content":{"rendered":"<div data-elementor-type=\"wp-post\" data-elementor-id=\"2903\" class=\"elementor elementor-2903\">\n\t\t\t\t<div class=\"elementor-element elementor-element-10a363b e-con-full e-flex e-con e-parent\" data-id=\"10a363b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c9af283 elementor-widget elementor-widget-html\" data-id=\"c9af283\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n<div id=\"bh\">\n\n<section class=\"hero\">\n  <div class=\"in\">\n    <p class=\"eyebrow\">Kidney transplantation \u00b7 Before the transplant<\/p>\n    <h1>Hepatitis B or C does not close the door<\/h1>\n    <p class=\"lead\">Many patients are told their hepatitis rules out a transplant. For most,\n       that has not been true for years \u2014 and the reasoning behind the refusal is often\n       out of date.<\/p>\n    <p class=\"meta\">Written by <b style=\"color:#fff\">Prof. Dr. Murat Tuncer<\/b> \u00b7\n       Adapted from his book <i>Kidney Transplantation \u2014 With Questions and Answers<\/i><\/p>\n  <\/div>\n<\/section>\n\n<section class=\"wrap\">\n\n  <div class=\"ozet\">\n    <h2>The short answer<\/h2>\n    <ul>\n      <li>Patients with hepatitis B, hepatitis C, or both <b>can be transplanted<\/b> \u2014 provided\n          the liver is not already cirrhotic.<\/li>\n      <li>Advanced liver damage is found in roughly <b>1%<\/b> of transplant candidates. It is\n          the exception, not the rule.<\/li>\n      <li>For hepatitis B, modern antivirals and routine prophylaxis have brought long-term\n          survival <b>close to that of hepatitis-negative recipients<\/b>.<\/li>\n      <li>For hepatitis C, patients who receive a transplant have a <b>far lower death rate<\/b>\n          than hepatitis C patients who stay on dialysis.<\/li>\n      <li>If cirrhosis is present, the question changes from \"kidney\" to\n          <b>\"combined liver and kidney\"<\/b> \u2014 which is still a transplant, not a refusal.<\/li>\n    <\/ul>\n  <\/div>\n\n  <h2>Why hepatitis used to be a barrier \u2014 and why it no longer is<\/h2>\n\n  <p>Hepatitis remains a significant issue in dialysis populations. In countries with low\n     prevalence, hepatitis B surface antigen (HBsAg) positivity among dialysis patients runs\n     between 0 and 7%. In endemic regions it reaches <b>10 to 20%<\/b>. Hepatitis C is similarly\n     over-represented, largely because of blood transfusions and transmission within dialysis\n     units.<\/p>\n\n  <p>For years this meant caution, and in many centres refusal. Two developments changed that:\n     the arrival of effective antiviral drugs, and the practice of giving preventive treatment\n     immediately after transplantation.<\/p>\n\n  <div class=\"box\">\n    <span class=\"etiket\">What changed<\/span>\n    <p>Long-term survival rates of hepatitis B positive recipients now <b>approach those of\n      hepatitis B negative recipients<\/b>. What was once treated as a high-risk procedure has\n      become routine practice.<\/p>\n  <\/div>\n\n  <h2>Hepatitis B<\/h2>\n\n  <p><b>Hepatitis B infection is not an obstacle to kidney transplantation.<\/b> That is the\n     starting position, and the exceptions are specific rather than general.<\/p>\n\n  <h3>What should happen before a transplant<\/h3>\n\n  <ul>\n    <li><b>Every candidate is tested<\/b> for hepatitis B, whether or not there is a known\n        history.<\/li>\n    <li>If a patient is HBsAg-positive <b>and<\/b> shows markers of viral replication\n        (HBeAg positivity and\/or HBV-DNA positivity), a <b>full liver evaluation including\n        biopsy<\/b> is required \u2014 because the risk of progressive liver disease after\n        transplantation rises in this group.<\/li>\n    <li>If active liver disease is found, it is <b>treated before<\/b> transplantation, not\n        used as grounds for refusal.<\/li>\n    <li>If <b>cirrhosis<\/b> is present, kidney transplantation alone is not appropriate. The\n        patient should instead be evaluated for a <b>combined liver and kidney transplant<\/b>.<\/li>\n  <\/ul>\n\n  <h3>After the transplant<\/h3>\n\n  <p>Immunosuppression can allow the virus to reactivate, which is why preventive antiviral\n     treatment is given. Current guidelines recommend <b>universal prophylaxis<\/b> for all\n     patients at moderate to high risk of reactivation during immunosuppression \u2014 meaning the\n     treatment is given to everyone in the at-risk group, not only to those who show signs of\n     trouble.<\/p>\n\n  <p>All immunosuppressive drugs can be used in hepatitis B positive transplantation. The\n     principle is to keep <b>total immunosuppression at the lowest workable level<\/b> over the\n     long term.<\/p>\n\n  <div class=\"box\">\n    <span class=\"etiket\">Vaccination \u2014 the part that gets missed<\/span>\n    <p>Vaccination is the single most effective action against hepatitis B, and <b>timing\n      matters<\/b>. Patients with chronic kidney disease respond far better if vaccinated\n      <b>before<\/b> they start dialysis \u2014 roughly <b>90% versus 70%<\/b> immunogenicity.<\/p>\n    <p>If you are already on dialysis you should still be vaccinated, with an annual anti-HBs\n      antibody titre. <b>Below 10 IU\/mL, a booster is needed.<\/b> Ask when yours was last\n      checked.<\/p>\n  <\/div>\n\n  <div class=\"soru\">\n    <h3>I am a hepatitis B carrier. Can I donate a kidney to my daughter?<\/h3>\n\n    <p><b>Yes, in defined circumstances.<\/b> Kidneys from hepatitis B infected donors \u2014 living\n       or deceased \u2014 can be transplanted into recipients who are either HBsAg-positive\n       themselves or immunised, whether that immunity came from vaccination or from past\n       infection. Informed consent is required, and the recipient's HBsAb titre needs to be\n       above 10.<\/p>\n\n    <p>This is not a fringe practice waiting for evidence. <b>One of the first studies in the\n       world on this question was carried out by our team.<\/b><sup>1<\/sup><\/p>\n  <\/div>\n\n  <h2>Hepatitis C<\/h2>\n\n  <p>Worldwide, the World Health Organization estimates hepatitis C prevalence at around 3% \u2014\n     approximately 71 million people. Among kidney patients it is considerably more common.<\/p>\n\n  <p>Hepatitis C matters in transplantation because it can worsen liver damage and is a known\n     cause of transplant glomerulopathy, new-onset diabetes after transplantation, and\n     lymphoproliferative disorders. It can also cause chronic kidney disease in the first place,\n     principally through membranoproliferative glomerulonephritis arising from mixed\n     cryoglobulinemia.<\/p>\n\n  <p>None of that makes it a barrier.<\/p>\n\n  <div class=\"box\">\n    <span class=\"etiket\">The comparison that matters<\/span>\n    <p>The mortality rate of hepatitis C positive patients <b>who receive a kidney transplant<\/b>\n      is markedly lower than that of hepatitis C positive patients who remain on dialysis \u2014\n      particularly over the first ten years after transplantation.<\/p>\n    <p>In other words, the risk of transplanting a hepatitis C patient has to be weighed against\n      the risk of <b>not<\/b> transplanting them. That second risk is usually the larger one.<\/p>\n  <\/div>\n\n  <h3>What should happen before a transplant<\/h3>\n\n  <ul>\n    <li><b>Every candidate is tested<\/b> for anti-HCV antibodies.<\/li>\n    <li>Patients who are <b>anti-HCV positive but HCV RNA negative<\/b> carry a very low risk of\n        liver disease after transplantation.<\/li>\n    <li>A <b>liver biopsy<\/b> should be performed where HCV positivity is accompanied by raised\n        transaminases. Because transaminase levels are not a reliable indicator in dialysis\n        patients, some clinicians recommend biopsy for all hepatitis C positive candidates.<\/li>\n    <li>As with hepatitis B, <b>cirrhosis<\/b> redirects the question to combined liver and\n        kidney transplantation.<\/li>\n    <li>Active chronic hepatitis is <b>treated before<\/b> transplantation.<\/li>\n  <\/ul>\n\n  <div class=\"soru\">\n    <h3>I am hepatitis C positive. Can I donate to my son, who is negative?<\/h3>\n\n    <p>This was long considered out of the question. It is now an active area of practice.<\/p>\n\n    <p>The <b>EXPANDER-1 study<\/b> at Johns Hopkins University examined exactly this: kidneys\n       from hepatitis C infected donors transplanted into hepatitis C negative recipients, with\n       antiviral treatment started immediately after transplantation and continued for twelve\n       weeks, adjusted according to the donor's viral genotype.<\/p>\n\n    <p>The results, presented at the American Transplantation Congress in 2017, covered eight\n       patients. <b>Hepatitis C RNA was not detected in any of them after treatment, and no\n       graft failure was observed.<\/b><sup>2,3<\/sup><\/p>\n\n    <p>Kidneys from hepatitis C positive donors can also be transplanted into hepatitis C RNA\n       positive recipients with consent. In that case, establishing the genotypes of both donor\n       and recipient is appropriate.<\/p>\n  <\/div>\n\n  <h2>So what does actually rule a patient out?<\/h2>\n\n  <p>It is worth being direct about this, because vague refusals cause more harm than clear\n     ones. In the context of hepatitis, the genuine barriers are narrow:<\/p>\n\n  <div class=\"tblwrap\">\n    <table>\n      <thead>\n        <tr><th>Finding<\/th><th>What it means<\/th><\/tr>\n      <\/thead>\n      <tbody>\n        <tr>\n          <td>Hepatitis B or C, liver not cirrhotic<\/td>\n          <td><b>Transplantation can proceed<\/b>, with appropriate evaluation and prophylaxis<\/td>\n        <\/tr>\n        <tr>\n          <td>Replication markers present<\/td>\n          <td>Full liver evaluation including biopsy first \u2014 then decide<\/td>\n        <\/tr>\n        <tr>\n          <td>Active liver disease<\/td>\n          <td>Treated first, then reassessed<\/td>\n        <\/tr>\n        <tr>\n          <td><b>Cirrhosis<\/b><\/td>\n          <td>Kidney alone is not appropriate \u2014 evaluate for <b>combined liver and kidney<\/b><\/td>\n        <\/tr>\n        <tr>\n          <td><b>Active hepatitis<\/b> at the time of surgery<\/td>\n          <td>A definite contraindication until it is brought under control<\/td>\n        <\/tr>\n      <\/tbody>\n    <\/table>\n  <\/div>\n\n  <p>Note how narrow that last column is. Advanced liver findings occur in about <b>1%<\/b> of\n     potential recipients. If you have been refused, it is worth establishing which of these\n     rows applied to you \u2014 and whether it still does.<\/p>\n\n  <div class=\"yazar\">\n    <div class=\"rozet\">MT<\/div>\n    <div>\n      <h3><a href=\"https:\/\/bookinghospital.org\/az\/murat-tuncer-md\/\" style=\"color:inherit\">Prof. Dr. Murat Tuncer<\/a><\/h3>\n      <p>Nephrologist and transplant physician. Author of <i>Kidney Transplantation \u2014 With\n        Questions and Answers<\/i> (Istanbul, 2020). His published work includes one of the first\n        studies worldwide on kidney donation from hepatitis B surface antigen positive living\n        donors, and the first ABO-incompatible kidney transplantations performed in T\u00fcrkiye.<\/p>\n    <\/div>\n  <\/div>\n\n  <div class=\"cta\">\n    <h2>Refused because of hepatitis? Send us the reports<\/h2>\n    <p>Bring us your hepatitis serology, liver function tests and any biopsy result. We will\n       tell you honestly whether the refusal still stands under current practice \u2014 including\n       when the answer is that it does.<\/p>\n    <div class=\"btns\">\n      <a class=\"btn btn-1\" href=\"https:\/\/bookinghospital.org\/az\/tibbi-turizm\/\">Send your medical reports<\/a>\n      <a class=\"btn btn-2\" href=\"https:\/\/bookinghospital.org\/az\/kidney-transplant-compatibility\/\">Blood type &amp; tissue matching<\/a>\n    <\/div>\n  <\/div>\n\n  <div class=\"uyari\">\n    <p><b>Medical disclaimer.<\/b> This article is general information adapted from a published\n      book. It is not personal medical advice, it does not establish a doctor\u2013patient\n      relationship, and it cannot replace assessment by the physician treating you. Antiviral\n      regimens and transplant protocols differ between centres and change over time. Always\n      consult your own nephrologist, hepatologist or transplant centre before making decisions\n      about your treatment.<\/p>\n  <\/div>\n\n  <div class=\"kaynak\">\n    <h3>References<\/h3>\n    <ol>\n      <li class=\"kendi\"><b>Tuncer M<\/b>, Tekin S, Yucetin L, Sengul A, Demirbas A. Hepatitis B\n        surface antigen positivity is not a contraindication for living kidney donation.\n        <i>Transplant Proc<\/i> 2012;44(6):1628\u20139.<\/li>\n      <li>Durand C, Brown D, Wesson R, et al. EXPANDER-1: exploring renal transplants using\n        hepatitis C infected donors for HCV-negative recipients.\n        <i>Am J Transplant<\/i> 2017;17(suppl 3).<\/li>\n      <li>Molnar MZ, et al. Transplantation of kidneys from hepatitis C-infected donors to\n        hepatitis C-negative recipients: single centre experience.\n        <i>Am J Transplant<\/i> 2019;19(11):3046\u201357.<\/li>\n      <li>Marinaki S, Kolovou K, Sakellariou S, Boletis JN, Delladetsima IK. Hepatitis B in\n        renal transplant patients. <i>World J Hepatol<\/i> 2017;9(25):1054\u201363.<\/li>\n      <li>Lai TS, Lee MH, Yang HI, et al. Hepatitis C viral load, genotype, and increased risk\n        of developing end-stage renal disease: REVEAL-HCV study.\n        <i>Hepatology<\/i> 2017;66:784\u201393.<\/li>\n    <\/ol>\n  <\/div>\n\n<\/section>\n\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Kidney transplantation \u00b7 Before the transplant Hepatitis B or C does not close the door Many patients are told their hepatitis rules out a transplant. For most, that has not been true for years \u2014 and the reasoning behind the refusal is often out of date. Written by Prof. Dr. Murat Tuncer \u00b7 Adapted from [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"elementor_header_footer","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"_joinchat":[],"footnotes":""},"categories":[16],"tags":[],"class_list":["post-2903","post","type-post","status-publish","format-standard","hentry","category-kidney-transplant-guide"],"_links":{"self":[{"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/posts\/2903","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/comments?post=2903"}],"version-history":[{"count":4,"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/posts\/2903\/revisions"}],"predecessor-version":[{"id":2909,"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/posts\/2903\/revisions\/2909"}],"wp:attachment":[{"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/media?parent=2903"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/categories?post=2903"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/tags?post=2903"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}