Search PubMed⌕ Search

Biomedical subjects

Paul Martin

Publications and source records attributed to Paul Martin.

130 records · Page 8Linked to original sources
PubMedDate not supplied

Kinetics of hepatitis C virus load during hemodialysis: novel perspectives.

Hepatitis C virus (HCV) infection remains frequent among dialysis patients. The relationship between viral load and liver disease progression is currently a matter of debate; however, low HCV viral load (HCV RNA) is a well established predictor of successful antiviral treatment. Dialysis patients have immune compromise due to uremia; in spite of this, HCV viral load is not high and does not increase over time. A number of studies support the notion that this dynamics of HCV viral load may be related to lowering of HCV RNA titers during the HD procedure. It has been suggested that the intradialytic reduction of HCV is membrane-dependent; polysulphone (PS) and hemophan membranes appear more effective. Various mechanisms have been mentioned to explain the reduction of HCV RNA during hemodialysis (HD): adsorption of HCV onto dialysis membrane, HCV escape into spent dialysate, destruction of HCV particles or increased interferon (IFN) activity. Several investigators have noted that, at the end of the HD procedure, a virological rebound of HCV viremia occurs. Some suggestions have been made to minimize the risk for HCV escape into spent dialysate. However, controversial evidence on these issues exists: the HCV RNA reduction during HD procedures has not been seen in some studies and the relationship between the intra-dialytic reduction of HCV RNA titers and dialysis membrane is not completely understood. It is evident that additional long-term longitudinal studies by serial viral load estimations are needed to better define the dynamics of HCV viral load in the dialysis population.

Female↗
PubMedDate not supplied

Transplantation of kidneys from HCV-positive donors: a safe strategy?

Hepatitis C Virus (HCV) infection is the most important cause of liver disease after renal transplantation (RT). The impact of HCV on patient and graft survival after RT remains controversial; however, the great majority of studies with large size and adequate follow-up have shown the detrimental impact of HCV on long-term patient and graft survival after RT. The use of kidneys from anti-HCV positive donors could help decrease the continuing disparity between the number of patients on the transplant waiting list and the number of patients receiving a transplant each year. Single-center experiences have suggested transplanting kidneys from anti-HCV positive donors only in anti-HCV positive dialysis patients. Such practice has not demonstrated any adverse effect on the short-term patient survival; the waiting times for RT were shortened. A better alternative seems to be a policy of transplanting kidneys from anti-HCV positive donors only in HCV RNA positive recipients. This requires HCV RNA testing of all anti-HCV positive dialysis patients awaiting RT. Matching donors and recipients for HCV genotype has been suggested; however, the assessment of donor HCV genotype is currently hampered by time constraints. Recent evidence based on large data base demonstrated that RT recipients of HCV-positive donors are at independent increased risk of mortality; unadjusted 3-year patient survival was 85% versus 93% (P=0.01) in all recipients of donor HCV-positive and HCV-negative kidneys, respectively. This was observed in all recipient subgroups including elderly and HCV-positive recipients. In the near future, rapid nucleic acid testing (NAT) of donors and recipients will allow the assessment of the HCV viremic status in order to maximize organ use. With appropriate informed consent, use of a renal graft from an HCV positive donor may be offered to an HCV infected recipient. Additional studies are needed to clarify the link between donor HCV-positive kidneys and patient mortality.

Graft Survival↗