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Hepatitis C virus (HCV) infection is present in 20-50 % of end stage renal disease patients worldwide and contributes significantly to morbidity and mortality following renal transplantation (1,2). Infection with HCV is the leading cause of liver dysfunction in the renal transplant recipient and advanced liver disease and failure either directly or indirectly contributes to a significant number of deaths in the second decade post transplant. Although much has been learned about the impact of HCV infection in the ESRD population during the last ten years, most of this has come from single center experiences using data collected in a retrospective manner. Several studies have analyzed large data bases to better understand what effect HCV has in the renal transplant recipient, however these analyses are subject to the same criticisms, having analyzing retrospective data in patients that had not had a thorough baseline evaluation prior to transplant. Even such a fundamental and critical issue as the basis on which the diagnosis of HCV was made has been subject to great variability. Most studies have relied on the presence of a positive ELISA to make the diagnosis, whereas the 'gold standard ' is considered to be the presence of viral RNA in the serum detected by polymerase chain reaction. Not only have the earlier generation ELISA assays been shown to have poor sensitivity in the general population, but the problem is further accentuated by the blunted humoral response to viral infection often seen in the uremic patient. Taken together, it is easy to understand that the interpretation of the data that is available is of limited value and must be taken in the context of the issues mentioned above