Peginterferon alfa-2b plus ribavirin for the treatment of hepatitis C recurrence following combined liver and kidney transplantation.
BACKGROUND
Several studies have demonstrated safety and efficacy of treatment protocols using pegylated interferon alfa-2b (PegIntron) and ribavirin in hepatitis C (HCV) recurrence and liver transplantation but no data exists about antiviral treatment following combined liver and kidney transplantation.


METHODS
Six patients with recurrent HCV (genotype 1 [n = 5] and 4 [n = 1]) received peginter-feron alfa-2b (1 ug/kg/weekly) and ribavirin (600 mg) for 48 weeks. Sustained virologic response was defined as undetectable HCV-RNA 24 weeks after termination of therapy. All patients underwent liver biopsies prior to treatment and after 72 weeks and liver enzymes (ASAT) and serum creatinine levels were obtained regularly.


RESULTS
In 4/6 patients, viral load prior to treatment was below 1,000,000 (IU/mL). SVR was achieved in 3/6 (50%) patients. None of the patients developed signs of deteriorating kidney function or rejection. One patient without SVR had HCV related liver graft failure and died 13 months later. Side effects like neutropenia (50%) and anemia (50%) were treated with G-CSF, erythropoietin, and dose reduction of peginterferon and ribavirin.


CONCLUSIONS
In a small group of patients with combined kidney and liver transplantation, peginterferon-alfa2b is safe and effective to achieve SVR in HCV recurrence. Larger scale studies are warranted to further validate our results.
Schmitz
Volker
V
Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow, Berlin, Germany. volker.schmitz@charite.de
Kiessling
Anja
A
Bahra
Marcus
M
Puhl
Gero
G
Kahl
Andreas
A
Berg
Thomas
T
Neuhaus
Ruth
R
Neuhaus
Peter
P
Neumann
Ulf
U
D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage*; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D012008:Recurrence; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage*; D016896:Treatment Outcome
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b