Results of Treatment of Chronic Hepatitis C with Recombinant Interferon Alpha (rINF-alpha) in Pre- and Post-transplant Patients

Kim, Hyung Wook; Choi, Bum Soon; Kim, Mi Kyung; Ha, Byung Whoa; Park, Joo Hyun; Yang, Chul Woo; Kim, Yong Soo; Kim, Suk Young; Choi, Euy Jin; Chang, Yoon Sik; Moon, In Sung; Koh, Yong Bok; Bang, Byung Kee

Abstract

PURPOSE: Recombinant Interferon-alpha (rIFN-alpha) treatment is effective in treating chronic hepatitis C in the patients with end stage renal disease, and is also effective in preventing reactivation of hepatitis C virus (HCV) after renal transplantation. We here report our experience of rIFN-alpha treatment in renal transplant recipients and dialysis patients awaiting transplantation.
METHODS
Total nine patients were enrolled. Four patients (2 Hemodialysis patients, 2 Peritoneal dialysis patients) were on waiting lists for renal transplantation and five patients were renal transplant recipients. All the patients were HCV antibody and HCV RNA positive with elevated ALT more than normal limit for at least 6 months. Five renal transplant recipients had stable renal function for at least 6 months. rIFN-alpha at a dose of 3 million units was administered by subcutaneous injection three times a week for 6 months. Two renal transplant recipient received rIFN-alpha in combination with ribavirin (600 mg orally per day).
RESULTS
At the end of treatment, the rate of virological response (negative conversion of HCV RNA) was 67% (6/9 cases), and biochemical response (normalized ALT) was 88% (8/9 cases). The virological responders showed sustained loss of HCV RNA (sustained virological response 67%). and 7 out of 8 biochemical responder had normal ALT during follow-up period (sustained biochemical response 77%). Two patients who showed negative conversion of HCV RNA in the pre- renal transplantation period showed sustained loss of HCV RNA and normal ALT over post-renal transplantation period. There was no irreversible renal failure and acute rejection episode in renal transplant recipients during treatment of rIFN-alpha except one recipient with reversible and mild renal dysfunction, but two case of combination therapy of rIFN-alpha and ribavirin had hemolytic anemia.
CONCLUSION
The rIFN-alpha therapy in pre-transplant patients may appear to exert a beneficial effect of the liver disease following renal transplantation and irreversible renal failure does not develop in renal transplant recipients.