Acute Humoral Rejection in Hepatitis C‐Infected Renal Transplant Recipients Receiving Antiviral Therapy

Abstract

The use of interferon-alpha (IFN) in hepatitis C (HCV)-infected renal recipients has been associated with acute rejection and graft loss. We reviewed our recent experience in HCV (π) renal recipients treated with antiviral therapy for biopsy proven chronic hepatitis C. Twelve HCV (π) recipients who recently received antiviral therapy were analyzed. Post-treatment sera were tested for donor-specific human leukocyte antigen (HLA) antibodies (DSA). Within 6 months of initiating antiviral therapy, two of 12 patients (17%) developed acute rejection, which was characterized as acute humoral rejection (de novo DSA in serum and C4d deposits in peritubular capillaries). Both progressed to graft failure. Nine of the remaining 10 patients tested did not have DSA. The use of IFN was associated with severe acute humoral rejection (C4d π, DSA π). The recognition of IFN-associated acute humoral rejection in this series may explain the high rate of graft loss reported previously in renal recipients receiving IFN.

Viral Infection in the Renal Transplant Recipient

“…IFN treatment of HCV infection carries a risk for graft rejection in renal transplant recipients and such use needs to be very carefully evaluated (186,194). This observation has stimulated studies of lower-dose IFN-␣ (1 ϫ 10 units subcutaneously three times/wk) plus ribavirin (600 mg/d).…”

Renal Transplant Recipient with Chronic Hepatitis C Who Obtained Sustained Viral Response after Interferon-.BETA. Therapy

“…In renal transplant recipients with high HCV load, good effectiveness was observed when combination therapy was attempted. However, 2 of 11 patients experienced acute renal failure and graft loss (14). Other studies have demonstrated good effectiveness of IFN therapy when used in hemodialysis patients with chronic hepatitis C (22)(23)(24).…”

“…Several reports have investigated the utility of IFN therapy for chronic hepatitis C in renal transplant recipients (Table 2) (3,(6)(7)(8)(9)(10)(11)(12)(13)(14). However, only a few of these reports studied the response in terms of HCV viral load and the response of individual HCV genotypes to therapy (7,13,14).…”

“…Acute rejection of the renal graft occurred in 15 to 100% of recipients receiving IFN therapy (3,(6)(7)(8)(9)(10)(11)(12)(13)(14). The time from initiation of therapy to rejection was variable, with nearly all episodes occurring between 0.3 and 8 months (median, 3 months).…”

“…However, only a few of these reports studied the response in terms of HCV viral load and the response of individual HCV genotypes to therapy (7,13,14). IFN-was used in all cases, most typically for 6 month periods.…”