Alpha-interferon therapy for chronic hepatitis C may induce acute allograft rejection in kidney transplant patients with failed allografts.

Department of Nephrology, CHU Rangueil, 1 av. Jean Poulhès, 31059, Toulouse Cédex 9, France.

BACKGROUND: In hepatitis C virus (HCV) positive kidney transplant (KT) patients, the use of alpha-interferon (alphaIFN) is contraindicated due to the risk of acute rejection (AR). Conversely, if these HCV(+) KT patients lose their allograft, re-transplantation might be contemplated provided alphaIFN therapy has been attempted. METHODS: Between 01/01/1989 and 31/12/1994, 261 kidney transplantations were performed; of these 174 were HCV(-) (group I) and 87 were HCV(+) (group II). RESULTS: At last follow-up (2006), in group I, the number of patients with a functioning graft, the number of patients who died with a functioning graft, and the number of patients who lost their graft before or after month (M) 12 were 92 (52.8%), 14 (8%), 20 (11.5%) and 48 (27.7%), respectively. In group II, the corresponding figures were 22 (25.3%; P < 0.0001), 8 (9.1%; ns), 9 (10.3%; ns) and 48 (55.3%; P < 0.0001). In group I, 19 of 48 (39.5%) patients with failed allografts after M12 underwent transplantectomy (TX) compared to 14 of 48 (29%; ns) in group II. In group II, 11 of 48 (23%) patients were offered alphaIFN therapy after their allograft failed: of these, four (36.3%) developed AR during alphaIFN therapy leading to TX. Histology, in addition to chronic allograft lesions, showed acute cellular and vascular lesions. In patients who were not offered alphaIFN therapy, TX was performed less frequently, i.e. in only six cases (16.2%). CONCLUSIONS: We conclude that even alphaIFN-treated KT patients with a failed allograft can experience acute allograft rejection that requires transplantectomy during therapy.

PMID: 17913730 [PubMed - indexed for MEDLINE]

Rituximab induces complete remission in a case of membranous nephropathy associated with hepatitis C virus- related infection.

PMID: 17686812 [PubMed - indexed for MEDLINE]

Comment in:

Nephrol Dial Transplant. 2008 Jun;23(6):2104; author reply 2104-5.

Travel-associated acquisition of hepatitis C virus infection in patients receiving haemodialysis.

Department of Virology, Royal Free Hospital and Royal Free & University College Medical School, Rowland Hill Street, London NW3 2PF, UK.

BACKGROUND: It has been proposed that hepatitis C virus (HCV)-infected patients with end-stage renal disease undergoing maintenance haemodialysis may lack HCV antibody (anti-HCV) despite chronic HCV viraemia. This carries important implications for the design of surveillance policies. METHODS: To characterize the prevalence of antibody-negative/RNA-positive HCV infection, patients attending seven haemodialysis units underwent anti-HCV testing using a third-generation assay and HCV RNA testing using real-time PCR. RESULTS: At screening, anti-HCV prevalence was 12/360 (3.3%; 95% CI 1.7-5.8%); 7/12 (58.3%) anti-HCV positive samples were HCV RNA positive. Among anti-HCV-negative samples, 2/348 (0.6%; 95% CI 0.2-2.1%) tested HCV RNA positive (genotype 1a). Retrospective testing of stored sera dated the infections to a period of holiday in the Indian subcontinent. The two infections were unrelated by HCV-NS5B sequencing. Only one of the two newly infected persons showed raised transaminases. Both developed anti-HCV within 8-13 weeks of follow-up. Prospective surveillance of travellers to resource-limited countries returning to the units showed a HCV incidence of 4/153 travel episodes (2.6%; 95% CI 0.7-6.6%) among 131 persons (3.1%; 95% CI 0.8-7.6%). CONCLUSIONS: Among haemodialysis patients in the United Kingdom, antibody-negative/RNA-positive HCV status is associated with newly acquired infection, rather than lack of antibody responses in chronic HCV infection. There is a significant risk of HCV infection associated with travel to resource-limited countries. Given that transaminase levels may be normal, HCV RNA testing is recommended in patients re-entering a dialysis unit following haemodialysis in settings where suboptimal infection control policies pose a risk of exposure to blood-borne viruses.

PMID: 17535845 [PubMed - indexed for MEDLINE]

Hepatitis C virus: from entry to renal injury--facts and potentials.

PMID: 17478492 [PubMed - indexed for MEDLINE]

Diabetes mellitus after kidney transplantation: a French multicentre observational study.

Service de Néphrologie, Dialyse et Transplantation, CHU Rangueil, 1 avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France. kamar.n@chu-toulouse.fr

BACKGROUND: New-onset diabetes mellitus (NODM)-a common complication of kidney transplantation-is associated with increases in graft loss, morbidity and mortality. METHODS: This is a purely observational study of 527 patients taking a calcineurin inhibitor (CNI), based on data collected at a single routine visit 6-24 months after kidney transplantation. Diabetes was defined according to ADA/WHO guidelines. RESULTS: The mean age of the patients was 47.2 years and 61.1% were men; 49.5% were receiving cyclosporine microemulsion (CsA-ME) and 50.5% tacrolimus (Tac). NODM developed in 7.0% after a median interval of 1.6 months. In CsA-ME-treated patients, the unadjusted cumulative risks of NODM were 5.5% and 8.4% at 1- and 2-year post-transplantation, while in Tac-treated patients, the risks were respectively 17.4% and 21%. Four independent risk factors (RFs) were identified by multivariate analysis: maximum lifetime body mass index>25 [odds ratio (OR)=5.1], pre-transplantation impaired fasting glucose (OR=4.7), hepatitis C status (OR=4.7) and Tac vs CsA-ME treatment (OR=3.0). CONCLUSIONS: NODM is associated with certain RFs present prior to kidney transplantation, and with treatment with Tac as opposed to CsA-ME.

PMID: 17400559 [PubMed - indexed for MEDLINE]

Hepatitis C, HCV genotypes and hepatic siderosis in patients with chronic renal failure on haemodialysis in Brazil.

Infectious and Parasitic Diseases Branch, Internal Medicine Department, Medical School of the Federal University of Minas Gerais, Av. Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, Minas Gerais 30130-100, Brazil.

BACKGROUND: The aim of this study was to investigate the HCV genotypes, hepatic siderosis, inflammatory activity and fibrosis of the liver in patients with chronic renal failure (CRF) on haemodialysis in Brazil. METHODS: A cohort of 72 CRF patients was compared with a group of 65 candidates for blood donation (CBD). For the subjects selected, who tested positive for anti-HCV antibodies and were HCV-PCR positive, a protocol with epidemiological, clinical and laboratory information was completed. An ultrasound-guided liver biopsy was performed and histological analysis of liver fragments was carried out. The presence of HCV-RNA in plasma was established by nested-RT-PCR. The genotype was determined by Restriction Fragment Length Polymorphism (RFLP) analysis of the PCR product. RESULTS: HCV genotype 1 was predominant in both groups, but genotype 2 was the second most common amongst CRF patients, and there was a significant difference when compared with the CBD group (P=0.016). Regarding inflammation and fibrosis, no significant difference was observed in the histology of the liver between the study groups. Siderosis of the liver was more prevalent in the CRF group (P=0.000). Severe complications of liver biopsies were reported in 10 CRF patients (13.2%). CONCLUSIONS: Genotype 2 was observed more frequently in the haemodialysis group. No statistically significant difference was detected between the CRF and CBD groups with regard to both inflammatory response and liver fibrosis. Hepatic siderosis has been attributed to excessive iron administration. As percutaneous liver biopsy resulted in severe complications, we suggest that other procedures of evaluating liver damage in CRF patients should be looked at thoughtfully.

PMID: 17309883 [PubMed - indexed for MEDLINE]

Minimal-change nephropathy and chronic hepatitis C infection: coincidental or associated?

PMID: 17210595 [PubMed - indexed for MEDLINE]

Successful treatment of severe/active cryoglobulinaemic membranoproliferative glomerulonephritis associated with hepatitis C virus infection by means of the sequential administration of immunosuppressive and antiviral agents.

PMID: 16782995 [PubMed - indexed for MEDLINE]

Rituximab induces regression of hepatitis C virus-related membranoproliferative glomerulonephritis in a renal allograft.

Department of Nephrology, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. 35830obm@comb.es

PMID: 16751656 [PubMed - indexed for MEDLINE]

Comment on:

Nephrol Dial Transplant. 2006 Feb;21(2):437-43.

Pegylated interferon and ribavirin in haemodialysis patients.

PMID: 16517569 [PubMed - indexed for MEDLINE]

Does hepatitis C virus affect the reactivation of hepatitis B virus following renal transplantation?

Department of Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.

BACKGROUND: Hepatitis B virus (HBV) is endemic in Taiwan. Transplantation followed by long-term immunosuppressive medications may precipitate HBV reactivation. Interference of hepatitis C virus (HCV) with HBV gene expression and replication has been confirmed in many studies involving non-transplant populations. This study investigates the incidence of HBV reactivation following renal transplantation and compares the clinical outcome, especially the liver outcome, of patients with or without HCV co-infection. METHODS: Fifty-one of 512 renal transplant recipients were positive for hepatitis B surface antigen before surgery, and were followed for 81.6+/-7.5 (4-120) months. Seventeen of 51 patients acquired HCV before transplantation and six patients acquired HCV after renal transplantation. RESULTS: At the end of this assessment, we had 28 patients who suffered HBV reactivation and another 23 patients who suffered no HBV reactivation. Initially, we found a significant difference of HCV carriage (P<0.05) between patients with (seven out of 28 or 25%) or without (21 out of 23 or 91.3%) HBV reactivation. Further inspection showed that 21 of the 28 patients without HCV co-infection and seven of the 23 patients with HCV co-infection suffered HBV reactivation. After comparison, we found a lower incidence of HBV reactivation in patients with HCV co-infection than in patients without HCV co-infection (P<0.05). In contrast to the latter, we found that patients with HCV co-infection suffering HBV reactivation tended to have a late onset of HBV reactivation (P<0.05). Otherwise, there was no difference in hepatitis severity, in terms of peak alanine aminotransferase, total bilirubin levels and hepatitis reactivation-related death, between these two groups of patients. Finally, a multivariable analysis also revealed that HCV carriage was indeed an independent variable leading to the reduced incidence of HBV reactivation in patients with HCV co-infection. CONCLUSION: HCV might affect the reactivation of HBV by decreasing the incidence or delaying the onset of HBV reactivation in renal transplant recipients carrying both HBV and HCV.

PMID: 16390851 [PubMed - indexed for MEDLINE]