title: Alpha-interferon therapy for chronic hepatitis C may induce acute allograft rejection in kidney transplant patients with failed allografts.
abstract: BACKGROUND
  In hepatitis C virus (HCV) positive kidney transplant (KT) patients, the use of alpha-interferon (alphaIFN) is contraindicated due to the risk of acute rejection (AR). Conversely, if these HCV(+) KT patients lose their allograft, re-transplantation might be contemplated provided alphaIFN therapy has been attempted.
  
  
  METHODS
  Between 01/01/1989 and 31/12/1994, 261 kidney transplantations were performed; of these 174 were HCV(-) (group I) and 87 were HCV(+) (group II).
  
  
  RESULTS
  At last follow-up (2006), in group I, the number of patients with a functioning graft, the number of patients who died with a functioning graft, and the number of patients who lost their graft before or after month (M) 12 were 92 (52.8%), 14 (8%), 20 (11.5%) and 48 (27.7%), respectively. In group II, the corresponding figures were 22 (25.3%; P < 0.0001), 8 (9.1%; ns), 9 (10.3%; ns) and 48 (55.3%; P < 0.0001). In group I, 19 of 48 (39.5%) patients with failed allografts after M12 underwent transplantectomy (TX) compared to 14 of 48 (29%; ns) in group II. In group II, 11 of 48 (23%) patients were offered alphaIFN therapy after their allograft failed: of these, four (36.3%) developed AR during alphaIFN therapy leading to TX. Histology, in addition to chronic allograft lesions, showed acute cellular and vascular lesions. In patients who were not offered alphaIFN therapy, TX was performed less frequently, i.e. in only six cases (16.2%).
  
  
  CONCLUSIONS
  We conclude that even alphaIFN-treated KT patients with a failed allograft can experience acute allograft rejection that requires transplantectomy during therapy.
authors.affiliation: Department of Nephrology, CHU Rangueil, 1 av. Jean Poulhès, 31059, Toulouse Cédex 9, France.
authors.forename: Hugo
authors.initials: H
authors.lastname: Wéclawiack
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Marion
authors.initials: M
authors.lastname: Mehrenberger
authors.forename: Céline
authors.initials: C
authors.lastname: Guilbeau-Frugier
authors.forename: Anne
authors.initials: A
authors.lastname: Modesto
authors.forename: Jacques
authors.initials: J
authors.lastname: Izopet
authors.forename: David
authors.initials: D
authors.lastname: Ribes
authors.forename: Federico
authors.initials: F
authors.lastname: Sallusto
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D006084:Graft Rejection / Q000139:chemically induced* / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use*; D007668:Kidney / Q000473:pathology / Q000601:surgery; D007674:Kidney Diseases / Q000628:therapy; D016030:Kidney Transplantation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D014184:Transplantation, Homologous
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha