Adacolumn treatment in kidney transplant patients with hepatitis C virus.
BACKGROUND
Patients who have undergone kidney transplantation and suffer from hepatitis C (HCV) cannot be treated with standard therapy (pegylated interferon combined with ribavirin) due to the risk of acute rejection. Furthermore, immunosuppressive therapy facilitates the progression of infection and chronic hepatopathies. Monocytes and macrophages are known to produce extrahepatic breeding sites that spread disease. Our aim was to reduce macrophages, granulocytes, monocytes, proinflammatory cells, and viremia levels using an extracorporeal device: Adacolumn Leukocyte Apheresis (Otzuka Electronics, Japan).


METHODS
The Adalcolumn filter is filled with 2-mm cellulose acetate beads immersed in sterile saline solution. These carriers absorb granulocytes and monocytes/macrophanges through their FCR receptors. Six patients affected by viral genotype 1b underwent five 1-hour treatments for 5 consecutive days.


RESULTS
Viremia was reduced in Patients 1, 2, 4, and 6 in association with decreased pro-inflammatory cytokine levels and a normal CD4/CD8 T-cell ratio, after 3 months. Subjects 1 and 3 showed inverted CD4(+)/CD8(+) T-cell ratios, which changed at 4-month follow-up in only patient 1. Subject 5 did not show any changes.


CONCLUSIONS
The treatment was safe without hemodynamic or infectious complications, suggesting that this method could be used in a greater number of patients to evaluate amelioration of increased viremia.
Novelli
G
G
Dipartimento "P. Stefanini" Chirurgia Generale e Trapianti d'Organo, La Sapienza Università di Roma, Rome, Italy. novelligilnardo@virgilio.it
Rossi
M
M
Ferretti
G
G
Poli
L
L
Pretagostini
R
R
Ruberto
F
F
Morabito
V
V
Cinti
P
P
Nudo
F
F
Mennini
G
G
Berloco
P B
PB
D015897:Comorbidity; D016207:Cytokines / Q000097:blood; D004867:Equipment Design; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D016030:Kidney Transplantation; D007937:Leukapheresis / Q000295:instrumentation* / Q000379:methods; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D023001:Transplantation Tolerance; D014766:Viremia / Q000097:blood / Q000517:prevention & control*
D016207:Cytokines