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Hepatitis C therapy with long term remission after renal transplantation
S Bunnapradist1, F Fabrizi, J Vierling
1Multi Organ Transplant Program, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA 90048, USA Bunnapradist@cshs.org
Insights
Hepatitis C virus (HCV) infection in dialysis patients can be successfully treated with interferon alpha. Successful antiviral therapy before renal transplantation prevents HCV relapse post-transplant, improving patient outcomes.
Area of Science:
- Nephrology
- Hepatology
- Virology
Background:
- Hepatitis C virus (HCV) infection is prevalent in end-stage renal disease (ESRD) patients.
- HCV negatively impacts patient and graft survival after renal transplantation.
- Interferon is a primary treatment for hepatitis C in ESRD, but long-term outcomes post-transplant are understudied.
Observation:
- A dialysis patient with hepatitis C underwent successful interferon alpha therapy.
- The patient subsequently received a renal transplant and aggressive immunosuppression.
- Regular monitoring over six years showed no biochemical or virological relapse of HCV.
Findings:
- Successful interferon alpha treatment in dialysis patients can lead to sustained virological response.
- Renal transplant recipients with a history of treated HCV can maintain undetectable viral loads post-transplant despite immunosuppression.
- This case demonstrates the long-term efficacy of interferon in managing HCV in ESRD patients undergoing transplantation.
Implications:
- Interferon therapy is a viable option for selected ESRD patients with hepatitis C before transplantation.
- Sustained HCV clearance may improve long-term graft and patient survival after renal transplantation.
- Further research into newer antiviral agents for HCV in transplant candidates is warranted.
Abstract:
Hepatitis C virus infection (HCV) is common in patients with end-stage renal disease (ESRD) and long observation periods have shown the detrimental effect of HCV infection on patient and graft survival after renal transplantation. At present, interferon is the most important agent for the treatment of hepatitis C in ESRD; however, limited information exists concerning the long-term response of patients who undergo renal transplantation after successful antiviral therapy. We describe the evolution of HCV infection in a dialysis patient with hepatitis C who was successfully treated with interferon alpha and then underwent renal transplantation. He received aggressive immunosuppression during the induction phase and for allograft rejection; however, regular screening showed complete absence of biochemical and virological relapse of HCV over a 6-year post-transplantation period. We conclude that interferon can offer excellent response in selected dialysis patients with hepatitis C. Alternative strategies with newer antiviral agents are currently under active investigation.