Journal Article

Alpha-interferon therapy for chronic hepatitis C may induce acute allograft rejection in kidney transplant patients with failed allografts

Hugo Wéclawiack, Nassim Kamar, Marion Mehrenberger, Céline Guilbeau-Frugier, Anne Modesto, Jacques Izopet, David Ribes, Federico Sallusto and Lionel Rostaing

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 23, issue 3, pages 1043-1047
Published in print March 2008 | ISSN: 0931-0509
Published online October 2007 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfm678
Alpha-interferon therapy for chronic hepatitis C may induce acute allograft rejection in kidney transplant patients with failed allografts

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Background. In hepatitis C virus (HCV) positive kidney transplant (KT) patients, the use of alpha-interferon (αIFN) is contraindicated due to the risk of acute rejection (AR). Conversely, if these HCV(+) KT patients lose their allograft, re-transplantation might be contemplated provided αIFN therapy has been attempted.

Methods. Between 01/01/1989 and 31/12/1994, 261 kidney transplantations were performed; of these 174 were HCV(-) (group I) and 87 were HCV(+) (group II).

Results. At last follow-up (2006), in group I, the number of patients with a functioning graft, the number of patients who died with a functioning graft, and the number of patients who lost their graft before or after month (M) 12 were 92 (52.8%), 14 (8%), 20 (11.5%) and 48 (27.7%), respectively. In group II, the corresponding figures were 22 (25.3%; P < 0.0001), 8 (9.1%; ns), 9 (10.3%; ns) and 48 (55.3%; P < 0.0001). In group I, 19 of 48 (39.5%) patients with failed allografts after M12 underwent transplantectomy (TX) compared to 14 of 48 (29%; ns) in group II. In group II, 11 of 48 (23%) patients were offered αIFN therapy after their allograft failed: of these, four (36.3%) developed AR during αIFN therapy leading to TX. Histology, in addition to chronic allograft lesions, showed acute cellular and vascular lesions. In patients who were not offered αIFN therapy, TX was performed less frequently, i.e. in only six cases (16.2%).

Conclusions. We conclude that even αIFN-treated KT patients with a failed allograft can experience acute allograft rejection that requires transplantectomy during therapy.

Keywords: acute allograft rejection; αIFN therapy; chronic hepatitis C; failed allograft; kidney transplant patient

Journal Article.  2771 words.  Illustrated.

Subjects: Nephrology

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