Introduction: Hepatitis C virus (HCV) infection is the most common blood borne infection that affects patients on maintenance hemodialysis. Treatment approaches to HCV has changed drastically over the past decade. Most studies had published short-term outcome of liver disease.. However, there is a paucity of data on the long term impact of HCV treatment among the renal allograft recipients outcomes. Present study was conducted to evaluate long-term outcome of these patients.
Material and Methods: This is a prospective cohort study, conducted in the Departments of Nephrology from August 2019 to February 2021 on transplant recipients followed prospectively. All Renal allograft recipients, aged > 18 years  infected with HCV at the time of renal transplantation done till 31st December 2019, were included in the study. Hepatitis C patients co infected with Hepatitis B or HIV were excluded. Data was captured during patients follow-up in renal transplant clinic run by our department. During the follow up; complete blood count, renal function tests, liver function tests, blood for HCV-RNA by polymerase chain reaction (PCR), and fibroscan was done.
Results :  Among the  2883 renal transplants done  from 1994 to 2019, a total of 364 patients had HCV infection. Of these, 208 patients were included in the study, as 64 patients died, 60 had graft loss and 32 were either loss to follow up or co infected with Hep B or HIV. As this study was conducted during the covid pandemic, therefore only 87 patients were able to complete the investigations as per the study protocol. Among them, 66 patients were treated, 56 with DAA and 10 with IFN based regimen. The mean age of the patients was 32.54 ± 9.13 years and 85% were males. The median follow up was 55 (29-75) months. Till the last follow up, 11 out of 21 (52.3%) among the untreated group had significant viral load whereas only one of the treated with IFN based regimen, had viremia. The median serum creatinine was 1.2 (1-1.5) mg/dl among the treated group vs 1.6 (1.2-1.9) mg/dl among the untreated group, (p - 0.008). The median serum alanine aminotransferase (ALT) levels were comparable in both the groups, treated -21.5 IU/L (18-28.2) vs 19 IU/L (16-27.5) untreated group. A total of 75 patients had fibroscan, among them 2 untreated patients had advanced liver scarring (cirrhosis) with the LSM score - 15 ± 1.2kPa(f4) and 10 ± 1.9 kPa(f3) in them, while only one patient in the treated group had evidence of severe liver scarring with  LSM score - 20.7± 3.4 kPa (f4). 
 

Conclusion :  Treatment of HCV infection in pre-transplant period during maintenance dialysis has significant benefit in liver disease outcomes among the renal allograft recipients with mean of 4.5 years of follow-up.