Preliminary results of treatment of chronic hepatitis C with recombinant interferon alpha in renal transplant patients

Chronic hepatitis C is a common cause of viral liver disease in kidney transplant recipients. To assess the efficacy and the safety of therapy with interferon alpha (IFNα) in such a population we conducted a prospective study where 16 kidney transplant recipients with chronic hepatitis C received recombinant IFNα 3 million units three times weekly scheduled for 24 consecutive weeks. All the patients had stable renal function for at least 1 year (mean serum creatinine 125.4±41 μmol/l). Fifteen patients had a positive HCV viraemia at the beginning of the study. In 15 patients serum alanine aminotransferase (ALT) levels decreased rapidly and normalized (48±44 vs 98.5±46 IU/l ; P=0.0044). ALT remained in the normal range as long as IFNα was continued. Serum levels of gamma glutamyl transpeptidase decreased from 129.75±111.2 to 88±85 IU/l ; P = 0.012). After discontinuation of IFNa therapy seven responders relapsed within 1-9 weeks. HCV viraemia assessed 1 month after the end of IFNα therapy remained positive in all the patients who scored positive at the beginning, i.e. 15. Side effects of IFNα (fatigue, anorexia, weight loss) were frequent leading to four patients dropping out of the study. The haematological tolerance was moderate. The major concern was the increase in serum creatinine (162.5±57.6 vs 125.4±41 μmol/l ; P<0.05). In fact only six patients experienced renal failure occuring 45-168 days after the beginning of IFNα. Kidney transplant biopsies showed oedema, scarce scattered interstitial inflammatory cellular infiltration and moderate mesangial hypertrophy. Methylprednisolone pulses improved renal function in only two cases ; the others had a progressive renal disease, leading one of them to haemodialysis. We conclude that IFNα therapy is effective in controlling disease activity in kidney transplant patients with hepatitis C although relapse after the cessation of treatment is common. Nevertheless the high rate of irreversible renal function impairing is unacceptable. Thus IFNα is not suitable for these patients.