Interferon Therapy in Hemodialysis Patients with Chronic Hepatitis C: Study of Tolerance, Efficacy and Post-Transplantation Course

Abstract

Background: The potential benefit of pre-transplant treatment of chronic hepatitis C on long-term evolution after renal transplantation is not clear. Methods: Fifty successive renal transplant candidates had their sera positive for HCV RNA and a biopsy-proven chronic hepatitis. Out of these, 18 patients received a standard course of interferon-α_2b (IFN; 3 MU three times weekly after hemodialysis sessions for 6 months). Results: IFN was discontinued in 2 patients (11%) due to persistent leukopenia. HCV RNA turned negative in 10 patients of the treatment group and in none of the control group. Two patients of the IFN group had a virological relapse post-transplantation. Post-transplant follow-up periods were 41.5 ± 15 and 50 ± 16 months for the treated and control groups respectively. Transaminases remained normal in all patients of the IFN group after transplantation. In contrast, biochemical evidence of acute and chronic hepatitis was observed in 5 (p = 0.03) and 13 (p = 0.002) patients, respectively, of the control group. Logistic regression analysis identified non-receiving IFN before transplantation as a risk factor for post-transplant hepatic dysfunction (odds ratio = 11.7, p = 0.003) and for chronic allograft nephropathy (odds ratio = 11.6, p = 0.02). Conclusions: IFN-treated patients had a significantly better post-transplant hepatic function and significantly lower rates of chronic allograft nephropathy.

Hepatitis C Infection and Chronic Renal Diseases

“…The high cost of the antiviral treatment, the risk of severe life-threatening side effects, and the lack of data on the impact of therapy and SVR response on mortality would encourage (72,80). On the contrary, dialysis patients with short life expectancy or with complications such as diabetes mellitus or congestive heart failure should be considered with caution for antiviral therapy (72).…”

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“…40 Type 1 MPGN is associated with accelerated loss of the graft, 28 whereas, with MGN, the clinical course and the development of renal failure appear to be similar in patients with and without HCV infection. 45 Fabrizi and associates 21 concluded in their meta-analysis (4 of 8 studies) that the presence of anti-HCV antibodies was an independent risk factor for graft failure (RR, 1.56). This finding was con firmed by Rostami and associates 46 in their systematic review of 18 observational studies.…”

Treatment of chronic hepatitis C in hemodialysis patients

“…Most studies investigating the use of conventional IFN alfa monotherapy in patients with chronic hepatitis C awaiting renal transplant are limited by small patient numbers, poor design features, or both (Table 1). 6,[11][12][13][14][15][16][17][18][19] The clinical applicability of conventional IFN alfa monotherapy is captured in the results of two meta-analyses. 20,21 The first analysis 20 included 14 studies with 269 patients, and the second analysis 21 included 11 studies with 213 patients.…”