PRELIMINARY-RESULTS OF TREATMENT OF CHRONIC HEPATITIS-C WITH RECOMBINANT INTERFERON-ALPHA IN RENAL-TRANSPLANT PATIENTS

Chronic hepatitis C is a common cause of viral liver disease in kidney transplant recipients. To assess the efficacy and the safety of thera py with interferon alpha (IFN alpha) in such a population we conducted a prospective study where 16 kidney, transplant recipients with chron ic hepatitis C received recombinant IFN alpha 3 million units three ti mes weekly scheduled for 24 consecutive weeks. All the patients had st able renal function for at least 1 year (mean serum creatinine 125.4+/ -41 mu mol/l). Fifteen patients had a positive HCV viraemia at the beg inning of the study. In 15 patients serum alanine aminotransferase (AL T) levels decreased rapidly and normalized (48+/-44 vs 98.5+/-46 IU/l; P=0.0044). ALT remained in the normal range as long as IFN alpha was continued. Serum levels of gamma glutamyl transpeptidase decreased fro m 129.75+/-111.2 to 88+/-85 IU/l; P=0.012). After discontinuation of I FN alpha therapy seven responders relapsed within 1-9 weeks. HCV virae mia assessed 1 month after the end of IFN alpha therapy remained posit ive in all the patients who scored positive at the beginning, i.e. 15. Side effects of IFN alpha (fatigue, anorexia, weight loss) were frequ ent leading to four patients dropping out of the study. The haematolog ical tolerance was moderate. The major concern was the increase in ser um creatinine (162.5+/-57.6 vs 125.4+/-41 mu mol/l; P<0.05). In fact o nly six patients experienced renal failure occuring 45-168 days after the beginning of IFN alpha. Kidney transplant biopsies showed oedema, scarce scattered interstitial inflammatory cellular infiltration and m oderate mesangial hypertrophy. Methylprednisolone pulses improved rena l function in only two cases; the others had a progressive renal disea se, leading one of them to haemodialysis. We conclude that IFN alpha t herapy is effective in controlling disease activity in kidney transpla nt patients with hepatitis C although relapse after the cessation of t reatment is common. Nevertheless the high rate of irreversible renal f unction impairing is unacceptable. Thus IFN alpha is not suitable for these patients.