Evidence that clearance of hepatitis C virus RNA after alpha-interferon therapy in dialysis patients is sustained after renal transplantation.
To date, there is no available treatment of hepatitis C virus (HCV) infection after renal transplantation (RT). Among 55 anti-HCV-positive/HCV RNA-positive hemodialysis patients who were treated with IFN-alpha (9 MU/wk during 6 or 12 mo), 21 of them (38%) had a sustained virologic response. Of these, 16 (76%) underwent RT 38 mo (range, 2 to 57 mo) after alpha-IFN therapy. There were 13 men and 3 women aged 46 yr (range, 27 to 68 yr). At RT, HCV serology was still positive in 15 patients, and HCV viremia was negative in all patients. Immunosuppression relied on anticalcineurin agents with or without steroids and/or antimetabolites; in addition, 12 of them received induction therapy with antithymocyte globulins. At the last follow-up after RT, at 22.5 mo (range, 2 to 88 mo), HCV viremia remained negative in all patients. Moreover, HCV RNA was not present in peripheral blood mononuclear cells when assessed in eight patients. HCV serology was found to be still positive in 13 patients. Three patients presented with acute rejection, one presented with a suppurative lymphocele, one died from a sepsis, and four presented with a cytomegalovirus infection. None of them developed posttransplant diabetes mellitus. In conclusion, hemodialysis patients waiting for a RT need to be treated with alpha-IFN because when HCV RNA clearance occurred, they experienced no relapse after transplantation despite chronic immunosuppressive treatment.
Kamar
Nassim
N
Department of Nephrology, Dialysis and Transplantation, CHU Rangueil, Toulouse, France.
Toupance
Olivier
O
Buchler
Matthias
M
Sandres-Saune
Karine
K
Izopet
Jacques
J
Durand
Dominique
D
Rostaing
Lionel
L
D000328:Adult; D000368:Aged; D016572:Cyclosporine / Q000378:metabolism; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000378:metabolism*; D006526:Hepatitis C / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D016898:Interferon-alpha / Q000627:therapeutic use*; D016030:Kidney Transplantation; D007963:Leukocytes, Mononuclear / Q000378:metabolism; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012313:RNA / Q000378:metabolism; D012367:RNA, Viral / Q000378:metabolism*; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects*
D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D012367:RNA, Viral; D012313:RNA; D016572:Cyclosporine