Abstract Hepatitis C virus (HCV) infection is present in 2–70% of patients receiving hemodialysis. The major risks for transmission are transfusions and nosocomial spread within dialysis units and the incidence has declined dramatically following the introduction of universal precautions and blood and organ donor screening. Renal transplantation confers an overall survival benefit in HCV+ hemodialysis patients, with similar 5-year patient and graft survival to those without HCV infection. However, long-term studies (more than 10 years) have reported increased liver-related and sepsis-related mortality in HCV-infected recipients. Attempts to eradicate HCV prior to transplant have been disappointing. Interferon is poorly tolerated in patients with end-stage renal disease and ribavirin is contraindicated because of universal severe hemolysis related to reduced renal clearance. Interferon is associated with unacceptable rates of allograft dysfunction and loss (attributed to interferon-induced rejection).