title: Acute allograft rejection following interferon therapy for hepatitis C in recipients who have returned to dialysis after kidney transplant failure: case study.
abstract: Interferon-based therapy remains the gold standard for hepatitis C in patients with chronic kidney disease; however, due to the high rate of IFN-induced rejection after transplant, treatment of HCV-infected kidney transplant recipients is recommended only in particular circumstances. We report the case of a 45-year-old Caucasian female with chronic hepatitis C (genotype 1b) who returned to hemodialysis following the complete functional loss of her kidney transplant. She started combination antiviral therapy with peg-IFN-α2a (135 mcg sc weekly) plus ribavirin (200 mg daily) nine months after the re-initiation of hemodialysis. Antiviral therapy was neither effective nor safe; ribavirin was stopped at week 38 due to hemolytic anemia; on-treatment HCV breakthrough was observed at week 48; and acute rejection occurred after four months of IFN-based therapy. Diagnosis of acute allograft rejection was suspected on the grounds of clinical, radiographic, and laboratory data. Allograft nephrectomy was then performed and histology showed acute-on-chronic rejection. This is an uncommon case of IFN-associated kidney rejection in an allograft recipient who had functional loss of her graft and had returned to hemodialysis. In view of the risk of rejection of renal allograft, and the limited efficacy of IFN-based treatment of hepatitis C, physicians should be aware of effective treatment with oral anti-viral agents and avoid the use of IFN in patients on maintenance dialysis with failed renal allograft.
authors.affiliation: 1 Division of Nephrology, Maggiore Hospital and IRCCS Foundation, University School of Medicine, Milan - Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fabrizi
authors.forename: Roberta
authors.initials: R
authors.lastname: D'Ambrosio
authors.forename: Francesco
authors.initials: F
authors.lastname: Pallotti
authors.forename: Luisa
authors.initials: L
authors.lastname: Berardinelli
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Messa
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
authors.forename: Alessio
authors.initials: A
authors.lastname: Aghemo
mesh_terms: D000208:Acute Disease; D064591:Allografts; D000998:Antiviral Agents / Q000009:adverse effects*; D001706:Biopsy; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology / Q000601:surgery; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D009392:Nephrectomy; D011092:Polyethylene Glycols / Q000009:adverse effects*; D011994:Recombinant Proteins / Q000009:adverse effects; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000628:therapy* / Q000821:virology; D012086:Reoperation; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D013812:Therapeutics; D013997:Time Factors
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a