Efficacy of interferon for chronic hepatitis C virus-related hepatitis in kidney transplant candidates on hemodialysis: Results after transplantation

OBJECTIVES: Interferon-alpha (IFN) may have undesirable effects on a functi oning graft. The aim of this study was to evaluate IFN treatment in kidney transplant candidates during the hemodialysis period as well as the results after transplantation. METHODS: A total of 29 noncirrhotic hemodialysis patients with chronic hepa titis C virus (HCV) infection (based on long-term rise in ALT, HCV serology , HCV RNA by polymerase chain reaction methods, and histological evidence) were included. Tolerability to IFN treatment, pre- and post-transplantation therapeutic results, and long-term outcome were recorded. IFN regimen cons isted of 3 million units (MU) times per week after hemodialysis sessions fo r 6 months. followed by 1.5 MU after each hemodialysis session for an addit ional 6 months. All patients gave informed consent for participation. RESULTS: IFN therapy was fairly well tolerated. Adverse effects due to IFN toxicity, renal disease, or causes related to the immunological properties of IFN were observed in 24% of patients. At the end of treatment, ALT had n ormalized in 23/28 patients (82.1%), and HCV RNA had cleared in 23/28 patie nts (82.1%). During follow-up, HCV RNA was persistently negative in 18 pati ents (64%, including transplant recipients). A total of 14 patients (nine H CV RNA-negative) received a kidney transplant. Mean follow-up after the pro cedure was 41 +/- 28 months. In all, 12 patients had a functioning graft, o ne had acute vascular rejection, and one died of carcinoma. All transplante d patients maintained normal ALT levels, and eight remained HCV RNA-negativ e. CONCLUSIONS: Treatment results in our study population were better than tho se observed in the general population. The long-term response achieved, whi ch was maintained after transplantation, supports the use of IFN for HCV he patitis in kidney transplant candidates under hemodialysis. (Am J Gastroent erol 2001;96:1170-1177. (C) 2001 by Am. Coll. of Gastroenterology).