Interferon Therapy in Hemodialysis Patients with Chronic Hepatitis C: Study of Tolerance, Efficacy and Post-Transplantation Course (original) (raw)
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Transplantation Proceedings, 2003
Hepatitis C virus (HCV) infection represents an important problem for hemodialysis patients especially following renal transplantation. We assessed the outcome of HCVpositive patients undergoing renal transplantation after treatment during the pretransplant period with alpha-interferon 2b (alpha-IFN2b). Data from all HCV-infected patients (n ϭ 38) undergoing renal transplantation from a cadaveric donor between January 1997 and June 2002 were retrospectively reviewed. Viral clearance was achieved in 7 of 13 patients receiving alpha-IFN2b monotherapy during the pretransplant period. Controls were HCV-negative renal transplantation recipients operated during the same period (n ϭ 273). HCV-positive compared to HCV-negative patients showed no differences in age, gender, underlying disease, donor type, or immunosuppressive regimen, but there were significant differences (P Ͻ .001) in the mean (ϮSD) time on dialysis (155 Ϯ 70 versus 43 Ϯ 47 months), retransplant incidence (26% versus 5%), immunization rate as assessed by panel reactive antibodies (PRA) peak Ͼ50% (55% versus 18%), or 1-year survival of recipients (88% versus 97%) and of grafts (76% versus 89%). In contrast, all seven HCV RNA-negative patients who were before transplantation survived to the end of follow up with functioning grafts in six subjects and remained with normal liver function and clearance of HCV RNA. We conclude that kidney transplantation in HCV-positive compared with HCV-negative patients shows lower recipient and graft survival rates, possibly due to the higher incidence of risk factors, such as duration of hemodialysis, higher retransplantation rate, or hyperimmunization. Responders to pretransplantation IFN therapy show an excellent prognosis of liver function and overall outcome close to HCV-negative renal transplant recipients.
Renal Failure, 2004
Interferon-alpha (IFN) has been accepted as an effective treatment for chronic hepatitis C virus (HCV) infection in hemodialysis (HD) patients. We prospectively assess the long-term clinical, biochemical, and virological effects of interferon in the treatment of HD patients with chronic HCV infection. This study was performed in 20 HCV-RNA-positive HD patients with evidence of chronic hepatitis on liver biopsy. The patients received IFN administered after HD sessions in doses ranging from 3 to 6 million units for 6 to 12 months. The patients were followed up for a period of 6 years with determinations of serial alanine aminotransferase (ALT) levels and serum HCV-RNA. At the time of the final follow-up, the patients had no cirrhosis or hepatocellular carcinoma. Among the nonresponder group, only 1 patient died due to sudden cardiac death. Sustained normal serum ALT levels occurred in 9 (45%) of the patients. Nine patients had variable ALT levels, and 2 patients had persistently elevated ALT levels. Eight (40%) patients were continuously HCV-RNA negative, whereas 12 patients (60%) had variable HCV-RNA results at the end of the 6-year follow-up. These findings show that the long-term clinical, biochemical, and virological response to interferon monotherapy is good in HD patients with HCV infection.
Interferon-α in chronic hepatitis C infection in dialysis patients
American Journal of Kidney Diseases, 1999
This study assesses the efficacy and adverse effects of interferon-␣ (IFN-␣) administered at a dosage of 3 million units three times weekly for 1 year in 17 hemodialysis patients with hepatitic C virus (HCV)-associated chronic hepatitis (biopsy proven). The patients were prospectively followed up for a period of 18 months. Liver biopsy was repeated after 6 months of treatment in 13 patients. Patients were classified according to the histological activity index. Biochemical and virological responses were evaluated at the end (end-of-treatment response) and 6 months after completion of therapy (sustained response). HCV RNA became negative in 76% of the patients after 12 weeks of treatment, in 88% after 12 months of treatment, and in 71% of the patients 6 months after completion of therapy. HCV genotype 4 was found in 60% of our population. Alanine aminotransferase (ALT) levels were initially increased in only 6 patients and normalized in 4 of these patients after 12 weeks of therapy, with end-of-treatment and sustained biochemical responses of 83% and 67%, respectively. Of 13 patients who underwent liver biopsies after 6 months of therapy, 11 patients (85%) showed histological improvement. One patient could not tolerate therapy because of marked lethargy and myalgia; the other patients had minor side effects that did not require discontinuation of treatment. Two patients received a cadaveric renal transplant after 1 year of IFN treatment, and they continued to maintain biochemical and virological responses after a follow-up of 17 and 28 months, respectively.
Daily Interferon Therapy for Hepatitis C Virus Infection in Liver Transplant Recipients
Transplantation, 2001
Methods. Twelve patients, at least 7 months posttransplant, with detectable hepatitis C virus RNA in serum and features of hepatitis C on liver biopsy were randomized to interferon-␣2a, 3 mU daily for 12 months (n)8؍ or no treatment (n.)4؍ The tolerability of daily interferon dosing in liver transplant recipients was evaluated and effects on hepatitis C virus RNA level, quasispecies evolution, and liver histology were studied.
Liver …, 2006
Background: Patients with end-stage renal disease (ESRD) show a high prevalence of hepatitis C, with a negative impact on the survival on hemodialysis and after renal transplantation. We evaluated the efficacy and tolerance of interferon-a (IFN-a) in HCV-infected ESRD patients on dialysis. Methods: Forty-six HCV-RNA-positive ESRD patients were studied. IFN-a regimen consisted of 3 million units three times a week for 12 months, and the patients were followed up for 6 months. End-of-treatment, and sustained biochemical and virological responses were evaluated and tolerance was assessed monthly. Results: A sustained virological response (SVR) was observed in 10/46 patients (22%) and in 10/29 who completed the treatment (34%). Alanine aminotransferase was elevated in 63% of the patients at the beginning of the study and returned to normal levels within the first month in all patients with SVR. Treatment was discontinued because of side effects in 11/46 patients (24%) and six patients (13%) were lost to follow-up. Conclusions: IFN-a monotherapy for hepatitis C in dialysis patients shows a high frequency of adverse effects. However, the SVR is high (34%) in patients who complete treatment, emphasizing the importance of careful selection and close follow-up in order to minimize and control possible side effects.
Journal of Medical Case Reports, 2011
Introduction Accelerated liver function deterioration has been recognized in renal transplant recipients infected with hepatitis C virus (HCV). Although combination therapy with interferon plus ribavirin has been established as the standard treatment for patients with chronic HCV, the high risk of allograft rejection associated with interferon therapy has greatly discouraged the clinical use of this regimen. In Asia, where chronic hepatitis B virus (HBV) is prevalent, dual infection with HBV and HCV poses an even greater challenge for clinical hepatologists. Case presentation In this article, we report the case of a 51-year-old Taiwanese man with dual infection with HBV and HCV prior to renal transplantation. Low-dose interferon (3 to 6 × 106 U/week) and ribavirin (100 mg/day to 200 mg/day) were prescribed following the reactivation of the man's HCV after renal transplantation. Additionally, lamivudine (100 mg/day) was administered concomitantly to prevent HBV reactivation. His ...
Liver international : official journal of the International Association for the Study of the Liver, 2006
Patients with end-stage renal disease (ESRD) show a high prevalence of hepatitis C, with a negative impact on the survival on hemodialysis and after renal transplantation. We evaluated the efficacy and tolerance of interferon-alpha (IFN-alpha) in HCV-infected ESRD patients on dialysis. Forty-six HCV-RNA-positive ESRD patients were studied. IFN-alpha regimen consisted of 3 million units three times a week for 12 months, and the patients were followed up for 6 months. End-of-treatment, and sustained biochemical and virological responses were evaluated and tolerance was assessed monthly. A sustained virological response (SVR) was observed in 10/46 patients (22%) and in 10/29 who completed the treatment (34%). Alanine aminotransferase was elevated in 63% of the patients at the beginning of the study and returned to normal levels within the first month in all patients with SVR. Treatment was discontinued because of side effects in 11/46 patients (24%) and six patients (13%) were lost to ...