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DAA Treatment HCV Pre-Transplant — ESENeph MCQ

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ModerateTransplantationDAA Treatment HCV Pre-TransplantESENeph

A 60-year-old woman with ESKD on haemodialysis has chronic hepatitis C (genotype 1a, untreated). She is being assessed for kidney transplantation. What is the recommended approach to HCV treatment in relation to transplantation?

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Correct answer: D — Treat with direct-acting antivirals before transplant listing

KDIGO 2022 and UKKA guidelines recommend treating HCV with direct-acting antivirals (DAAs) before or at the time of transplant listing. DAAs (e.g., glecaprevir/pibrentasvir) achieve >95% SVR rates and are safe in ESKD. Treatment before transplant avoids post-transplant drug interactions with immunosuppressants, prevents HCV-related graft disease, and enables receipt of HCV-positive donor organs (expanding the donor pool). HCV is NOT a contraindication to transplantation. Interferon-based regimens are obsolete and contraindicated post-transplant due to rejection risk.

Reference: KDIGO 2022 – Hepatitis C in CKD; UKKA 2019 – HCV and Transplantation