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TREATMENT WITH PEGYLATED INTERFERON BEFORE TRANSPLANTATION IMPROVES POSTTRANSPLANT OUTCOME IN DIALYSIS PATIENTS INFECTED WITH HCV
MARIJANA GULIN
; Opća bolnica Šibensko-kninske županije, Šibenik, Hrvatska
NIKOLINA BAŠIĆ JUKIĆ
; Klinički bolnički centar Zagreb i Sveučilište u Zagrebu, Medicinski fakultet, Zagreb, Hrvatska
Sažetak
Introduction: Dialysis patients with hepatitis C virus (HCV) infection are candidates for transplantation, but long-term patient and graft survival is less favorable than in non-infected patients. The primary objective of this study was to compare three-year graft and patient survival in patients treated with pegylated interferon alfa 2 (PEG-IFN) before transplantation (PEG YES group) and patients without specifi c anti-HCV treatment (PEG NO group). The secondary target was tracking of the following post-transplant complications: delayed graft function, graft rejection, urologic complications (wound infection, urinoma, lymphocele, bleeding), viral infections (polyoma BK/JC virus infection, varicella-zoster (VZV) infection, cytomegalovirus (CMV) infection), and incidence of neoplasia. Subjects and Methods: A retrospective analysis was done by reviewing medical charts of 28 patients with chronic HCV infection that received renal allograft at Zagreb UHC (2007-2010). Nine of 28 patients received 135 μg of PEG-IFN 2a weekly for 48 weeks, 1-4 years before transplantation. The mean age at the time of transplantation was 48.8 (17-61) years, dialysis vintage 14 (5-23) years. Six (66.7%) patients achieved sustained virological response (SVR) and were HCV-RNA negative before transplantation, while three patients did not achieve SVR. All patients received kidney allograft from deceased donors, immunosuppressive protocol included basiliximab or daclizumab, calcineurin inhibitor cyclosporine or tacrolimus, mycophenolate mofetil, and steroids. Results: Three-year graft survival was 78% in the PEG NO group and 88% in the PEG YES group, with patient survival of 89% and 100%, respectively.Post-transplant complications were less frequent in the PEG YES group. Delayed graft function was observed in 44.4%, while in the PEG NO group it occurred in 57.8%. Acute rejection was recorded in 25% of our patients, 31.58% in the PEG NO group and signifi cantly less (11.11%) in the PEG YES group; only one (11.1 %) patient treated with PEG-IFN developed acute allograft rejection, as opposed to six (32%) patients in the PEG NO group. Viral infections were more frequent in the PEG NO group; there was no difference in polyoma BK/JC virus infection (26.3%/33.3%) and VZV infection (10.5%/11.1%), but CMV infection was less common in the PEG YES group (42.1 %/22.2%). Only one case of malignancy (squamous cell carcinoma) was observed in a patient from the PEG YES group. Conclusion: HCV positive patients should be treated with pegylated interferon before transplantation in order to eradicate HCV, thus eliminating one of the risk factors for adverse outcome after transplantation. Our results demonstrated that treatment with pegylated interferon reduced the risk of acute allograft rejection after kidney transplantation.
Ključne riječi
hepatitis C; pegylated interferon; dialysis; transplantation; post-transplantation complications
Hrčak ID:
208472
URI
Datum izdavanja:
16.11.2018.
Posjeta: 939 *