TREATMENT OF CHRONIC HEPATITIS-C WITH RECOMBINANT INTERFERON-ALPHA INKIDNEY-TRANSPLANT RECIPIENTS

Chronic hepatitis C is a common cause of viral liver disease in kidney transplant (KT) recipient. To assess the efficacy and safety of thera py with interferon alpha we conducted a prospective study where 14 cad averic KT recipients with chronic hepatitis C received recombinant int erferon alpha-2b (IFNa) 3 million units three times weekly (scheduled) for 6 months (group A). 14 KT recipients with chronic hepatitis C wer e not treated and served as controls for the study period (group B). A ll the patients in both groups had had stable renal function for at le ast one year. All patients in both groups had a positive HCV viremia a t the beginning of the study. Patients of group A were treated for 142 +/-34.8 days (range 65-168); elevated serum aminotransferase (ALT) lev els decreased rapidly and significantly from 100.3+/-48.9 to 37.7+/-13 .9 IU/L (P=0.001); 10 patients (77%) were ''responders,'' whereas the others experienced a decrease in ALT values but without reaching the n ormal ranges. With a mean follow-up of twelve months after discontinua tion of IFNa therapy, 8 responders-i.e., 80%-relapsed within 1-20 week s. Only 4 patients had no detectable HCV viremia at the end of the IFN a; two of them already have abnormal values of ALT. Moreover HCV virem ia was present in all patients one month after the cessation of IFNa t reatment. Side effects of IFNa (fatigue, anorexia, weight loss) were f requent, and 3 patients decided to drop out of the treatment. The hema tological tolerance was good although there was a significant decrease in hemoglobin (11.9+/-1.7 vs. 13.4+/-1.7 g/dl; P=0.0044). In group B, serum ALT levels did not significantly decrease (84.2+/-47.6 vs. 105. 2+/-68.8 IU/L). At the end of the study period serum ALT levels were s ignificantly lower in group A than in group B (37.7+/-13.9 vs. 84.2+/- 47.6 IU/L, P=0.013). The major concern in group A was the occurrence o f 5 renal failures. Kidney transplant biopsies showed edema, no signif icant tubulitis, scarcely scattered interstitial inflammatory cellular infiltration, and mesangial thickening. Four patients received methyl prednisolone pulses but renal function improved in only two cases. We were not able to discover predictive factors of renal failure. We conc lude that IFNa therapy is effective in controlling disease activity-i. e., reducing aminotransferase levels in KT patients with chronic hepat itis C, although relapse and detection of HCV RNA after the cessation of treatment were observed, respectively, in 80% and 100% of patients. Finally the high rate of renal function impairment is unacceptable, T hus IFNa is not a suitable treatment for these patients.