BACKGROUND: Several studies have demonstrated safety and efficacy of treatment protocols using pegylated interferon alfa-2b (PegIntron) and ribavirin in hepatitis C (HCV) recurrence and liver transplantation but no data exists about antiviral treatment following combined liver and kidney transplantation. PATIENTS: Six patients with recurrent HCV (genotype 1 [n = 5] and 4 [n = 1]) received peginter-feron alfa-2b (1 ug/kg/weekly) and ribavirin (600 mg) for 48 weeks. Sustained virologic response was defined as undetectable HCV-RNA 24 weeks after termination of therapy. All patients underwent liver biopsies prior to treatment and after 72 weeks and liver enzymes (ASAT) and serum creatinine levels were obtained regularly. RESULTS: In 4/6 patients, viral load prior to treatment was below 1,000,000 (IU/mL). SVR was achieved in 3/6 (50%) patients. None of the patients developed signs of deteriorating kidney function or rejection. One patient without SVR had HCV related liver graft failure and died 13 months later. Side effects like neutropenia (50%) and anemia (50%) were treated with G-CSF, erythropoietin, and dose reduction of peginterferon and ribavirin. CONCLUSIONS: In a small group of patients with combined kidney and liver transplantation, peginterferon-alfa2b is safe and effective to achieve SVR in HCV recurrence. Larger scale studies are warranted to further validate our results.
BACKGROUND: Several studies have demonstrated safety and efficacy of treatment protocols using pegylated interferon alfa-2b (PegIntron) and ribavirin in hepatitis C (HCV) recurrence and liver transplantation but no data exists about antiviral treatment following combined liver and kidney transplantation. PATIENTS: Six patients with recurrent HCV (genotype 1 [n = 5] and 4 [n = 1]) received peginter-feron alfa-2b (1 ug/kg/weekly) and ribavirin (600 mg) for 48 weeks. Sustained virologic response was defined as undetectable HCV-RNA 24 weeks after termination of therapy. All patients underwent liver biopsies prior to treatment and after 72 weeks and liver enzymes (ASAT) and serum creatinine levels were obtained regularly. RESULTS: In 4/6 patients, viral load prior to treatment was below 1,000,000 (IU/mL). SVR was achieved in 3/6 (50%) patients. None of the patients developed signs of deteriorating kidney function or rejection. One patient without SVR had HCV related liver graft failure and died 13 months later. Side effects like neutropenia (50%) and anemia (50%) were treated with G-CSF, erythropoietin, and dose reduction of peginterferon and ribavirin. CONCLUSIONS: In a small group of patients with combined kidney and liver transplantation, peginterferon-alfa2b is safe and effective to achieve SVR in HCV recurrence. Larger scale studies are warranted to further validate our results.