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

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2008-03, Vol.23 (3), p.1043-1047
• Main Authors: Wéclawiack, Hugo, Kamar, Nassim, Mehrenberger, Marion, Guilbeau-Frugier, Céline, Modesto, Anne, Izopet, Jacques, Ribes, David, Sallusto, Federico, Rostaing, Lionel
• Format: Article
• Language: English
• Subjects: acute allograft rejection; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Biological and medical sciences; chronic hepatitis C; Emergency and intensive care: renal failure. Dialysis management; failed allograft; Graft Rejection - chemically induced; Graft Rejection - pathology; Hepatitis C virus; Hepatitis C, Chronic - drug therapy; Humans; Intensive care medicine; Interferon-alpha - adverse effects; Interferon-alpha - therapeutic use; Kidney - pathology; Kidney - surgery; Kidney Diseases - therapy; kidney transplant patient; Kidney Transplantation - pathology; Male; Medical sciences; Middle Aged; Renal Dialysis; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Transplantation, Homologous; αIFN therapy
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfm678

Background. In hepatitis C virus (HCV) positive kidney transplant (KT) patients, the use of alpha-interferon (αIFN) 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 αIFN 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 αIFN therapy after their allograft failed: of these, four (36.3%) developed AR during αIFN therapy leading to TX. Histology, in addition to chronic allograft lesions, showed acute cellular and vascular lesions. In patients who were not offered αIFN therapy, TX was performed less frequently, i.e. in only six cases (16.2%). Conclusions. We conclude that even αIFN-treated KT patients with a failed allograft can experience acute allograft rejection that requires transplantectomy during therapy.