HCV Treatment Response Persists After Kidney Transplantation

After kidney transplantation, use of immunosuppressive therapy to prevent organ rejection can result in increased HCV viremia. Past studies have shown that both patient and graft survival are lower in HCV positive compared with HCV negative kidney transplant recipients.

In the October 15, 200 issue of Transplantation, French researchers discussed hepatitis C treatment in patients receiving kidney dialysis and outcomes after kidney transplantation.

At present, they noted, there are few safe and effective options for treating hepatitis C after kidney transplantation:

Interferon-based therapy does not produce a sustained virological response in many patients, and is associated with a high rate of kidney failure.

Ribavirin and amantadine monotherapy are associated with a significant improvement in liver enzymes, but have no impact on HCV viremia.

Ribavirin may be indicated in cases of HCV-related glomerulopathy, because it can significantly decrease protein in the urine.

Combination interferon plus ribavirin, they wrote, "should only be given to those patients who have developed post-transplant fibrosing cholestatic hepatitis," and instead, patients with kidney dysfunction should be treated before transplantation.

In dialysis patients, the authors noted, the only recommended therapy as yet is conventional interferon alfa monotherapy. Pegylated interferon is under evaluation, but ribavirin is considered contraindicated because it can cause severe hemolytic anemia.

While sustained response rates with interferon monotherapy leave much to be desired, outcomes are promising in those who do respond.

"When HCV-positive dialysis patients with a sustained virological response undergo successful renal transplantation," the authors concluded, "very few suffer a virological relapse, thus emphasizing that these patients were cured."

12/01/28/06

Reference
N Kamar, D Ribes, J Izopet, and others. Treatment of Hepatitis C Virus Infection (HCV) After Renal Transplantation: Implications for HCV-Positive Dialysis Patients Awaiting a Kidney Transplant. Transplantation 82(7): 853-856. October 15, 2006.