NDT Advance Access originally published online on October 3, 2007
Nephrology Dialysis Transplantation 2008 23(3):1043-1047; doi:10.1093/ndt/gfm678
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Alpha-interferon therapy for chronic hepatitis C may induce acute allograft rejection in kidney transplant patients with failed allografts
1 Department of Nephrology, Dialysis and Multiorgan Transplantation 2 Department of Histopathology, CHU Rangueil, 1 av. Jean Poulhès, TSA 50032, 31059, Toulouse Cédex 9, France 3 Laboratory of Virology, CHU Purpan, Place Dr Baylac, TSA 40031, 31059 Toulouse Cédex 9, France 4 Department of Urology and Renal transplantation, CHU Rangueil, 1 av. Jean Poulhès, TSA 50032, 31059, Toulouse Cédex 9, France
Prof. Lionel Rostaing, Nephrology, Dialysis, and Multiorgan Transplant Unit, CHU Rangueil, 1 av. Jean Poulhès, 31059, Toulouse Cédex 9, France. Tel: +33-5-61-32-25-84; Fax: +33-5-61-32-28-64; Email: rostaing.l{at}chu-toulouse.fr
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Abstract |
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Background. In hepatitis C virus (HCV) positive kidney transplant (KT) patients, the use of alpha-interferon (
IFN) 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 IFN 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 IFN therapy after their allograft failed: of these, four (36.3%) developed AR during IFN therapy leading to TX. Histology, in addition to chronic allograft lesions, showed acute cellular and vascular lesions. In patients who were not offered IFN therapy, TX was performed less frequently, i.e. in only six cases (16.2%).
Conclusions. We conclude that even IFN-treated KT patients with a failed allograft can experience acute allograft rejection that requires transplantectomy during therapy.
Keywords: acute allograft rejection; IFN therapy; chronic hepatitis C; failed allograft; kidney transplant patient
Received for publication: 9. 7.07
Accepted in revised form: 4. 9.07
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