[Is there a place for ribavirin in the treatment for renal transplant patients infected by hepatitis C virus?].
Treatment of chronic hepatitis C in renal-transplant (RT) recipients with alpha-interferon is associated with a high rate of acute rejection. We therefore evaluated the biochemical, virological, histological efficacies, as well as the safety of one year ribavirin monotherapy in 16 HCV-(+) RNA (+) RT patients (group A) matched to 32 HCV-(+) RNA (+) RT patients (group B) who did not receive ribavirin. Ribavirin was initially started at a daily dose of 1000 mg and then adapted to hemoglobin level. Ribavirin monotherapy was associated with a significant decrease in AST, ALT and gamma glutamyl transpeptidase levels. Serum creatinine decreased as well. When proteinuria was present (n = 5), this decreased or disappeared. There was no significant changes in HCV viremia. The histological analysis of liver biopsies revealed a significant progression in liver fibrosis with no improvement in inflammation scores. There was a significant decrease in hemoglobin levels, despite an important support by recombinant erythropoeitin. However, in three cases, ribavirin therapy had to be stopped. In group B, after 1 year of follow up, there was a significant increase in serum ALT and creatinine values. Proteinuria decreased in only 2 of 12 patients. In conclusion, one year ribavirin therapy in HCV-(+) RNA (+)ve RT has no impact upon liver histology, although it improves liver enzyme levels. It impact upon renal function remains unknown. Nevertheless when proteinuria is present it disappears.
Service de néphrologie, dialyse et transplantation, CHU Toulouse-Rangueil, Toulouse.
N
N
Kamar
K
K
Sandres-Saune
J
J
Selves
D
D
Durand
J
J
Izopet
L
L
Rostaing
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006526:Hepatitis C / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D016030:Kidney Transplantation; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D011507:Proteinuria; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use*; D005723:gamma-Glutamyltransferase / Q000097:blood
D000998:Antiviral Agents; D006454:Hemoglobins; D012254:Ribavirin; D003404:Creatinine; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase