Ribavirin Treatment in Patients with Chronic Hepatitis C Infection Who Had Renal Transplantation

Karaca, Çetin; Beşışık, Fatih; Akyüz, Filiz; Dinçer, Dinç; Sever, Mehmet Şükrü; Ökten, Atilla

doi:10.1159/000085455

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…[53][54][55] In general, ribavirin monotherapy has little or no effect on HCV RNA levels, but reports of normalization of ALT levels have been documented in some patients. Furthermore, Fontaine et al 53 reported significant improvement in hepatic necroinflammatory activity and fibrosis in renal transplant recipients with hepatic bridging fibrosis or cirrhosis who were receiving ribavirin monotherapy (mean dose 724 mg/day for 22.6 months), 55 although these data have not been replicated in other studies.…”

Section: Hemodialysis Patients With Chronic Hepatitis C Awaiting Renamentioning

confidence: 99%

Treatment of chronic hepatitis C in hemodialysis patients

Berenguer

2008

Hepatology

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Hepatitis C virus (HCV) infection is especially problematic in patients with end-stage renal disease (ESRD) who are undergoing hemodialysis. Rates of HCV infection are higher among hemodialysis patients than in the general population, and several routes of transmission are thought to stem from the dialysis unit. Management of chronic hepatitis C is also more complicated in hemodialysis patients because of altered pharmacokinetics and a predisposition for drug-related toxicity, particularly ribavirin-induced anemia. Clinical trials of patients with chronic hepatitis C and healthy, functioning kidney grafts are rare because of the inherent dangers of graft rejection. As a result, most studies in patients with ESRD have focused on patients waiting for a kidney transplant. Additionally, because ribavirin is contraindicated in this patient population, many studies have examined monotherapy treatments. According to meta-analyses, conventional interferon alfa treatment yields a sustained virological response (SVR) rate of 37%, whereas studies of pegylated interferon alfa monotherapy have yielded SVR rates between 13% and 75%. Several small studies have also used the monitoring of ribavirin plasma concentrations or hemoglobin levels to facilitate the use of combination therapy. In light of the results from these clinical trials, we herein review treatment guidelines and recommend strategies to help optimize the treatment of patients with ESRD. Conclusion: There remains a lack of clarity surrounding the most effective treatment options for patients with chronic hepatitis C and ESRD. Treatment can be effective with many patients attaining SVR; however, unfavorable tolerability with interferon alfa-based therapy remains a concern and thus close supportive care should be aggressively pursued to help maintain adherence. (HEPATOLOGY 2008;48:1690-1699

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Section: Hemodialysis Patients With Chronic Hepatitis C Awaiting Renamentioning

confidence: 99%

Treatment of chronic hepatitis C in hemodialysis patients

Berenguer

2008

Hepatology

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“…The prescribed dose of ribavirin ranges from 400-1000 mg/day in different studies [59,72,94,103,117] although it has been advised to be calculated by formula considering creatinine clearance and Hb level [72, 118,119]. The duration of therapy has been reported to be varied from 3 to 30 months.…”

Section: Ribavirinmentioning

confidence: 99%

“…103,117]. Hemolysis, per se, may cause iron deposition in liver and thus progression of hepatic fibrosis [117].…”

Section: Amantadinementioning

confidence: 99%

Hepatitis C and renal transplantation: a review on historical aspects and current issues

Moghaddam

Alavian

Kermani

2008

Reviews in Medical Virology

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Chronic liver disease has a significant impact on the survival of renal transplant recipients with an incidence rate of 4-38%. Approximately, 8-28% of renal transplant recipients die due to chronic liver disease. Hepatitis C seems to be the leading cause of chronic liver disease in kidney recipients. Hepatitis C virus (HCV) infection has a wide range of prevalence (2.6-66%) among renal transplant recipients living in different countries with great genotype diversity in different parts of the world. Nowadays, antiviral drugs are used for the management of hepatitis C. Because of graft-threatening effects of some antiviral drugs used in HCV-infected renal transplant recipients, we specifically focused on HCV treatment after renal transplantation. Treatment of post-renal transplantation chronic liver disease with INF and ribavirin remains controversial. Anecdotal reports on post-renal transplantation hepatitis C demonstrate encouraging findings. This review summarises the most current information on diagnosis, treatment, prognosis, complications as well as the new aspects of treatment in HCV-infected renal transplant recipients. HCV belongs to the family of Flaviviridae, genus Hepacivirus.

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