Treatment issues surrounding hepatitis C in renal transplantation: A review

Kim, Edward; Ko, Hin Hin; Yoshida, Eric M.

doi:10.1016/s1665-2681(19)31580-7

Cited by 22 publications

(12 citation statements)

References 81 publications

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“…When indicated, systemic chemotherapeutics may be used to treat all variants of KS; however, their effectiveness, the duration of response, and the severity of side effects may vary. The systemic administration of IFN‐α, a drug frequently used in endemic KS, is associated with an increased risk for acute graft rejection in organ transplant recipients and should be avoided …”

Section: Treatmentmentioning

confidence: 99%

“…The systemic administration of IFN-a, a drug frequently used in endemic KS, is associated with an increased risk for acute graft rejection in organ transplant recipients and should be avoided. 48 Anti-HHV-8 drugs, such as ganciclovir and foscarnet, appear to reduce the risk for KS development, probably through their inhibitory effect on HHV-8 replication. 36 Antiangiogenic agents, such as thalidomide, as well as inhibitors of matrix metalloproteinase and vascular endothelial growth factor are amongst experimental approaches for the treatment of KS and may hold promise for better efficacy and lower toxicity.…”

Section: Treatmentmentioning

confidence: 99%

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Oral Kaposi's sarcoma: a review and update

Fatahzadeh

Schwartz

2013

Int J Dermatology

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Kaposi's sarcoma (KS) is an important mucocutaneous neoplasm with four well-known clinicopathologic types. Involvement of the oral cavity may be seen in all variants but is most common with AIDS-KS. The latter may signal undiagnosed HIV infection. Its common association with disseminated disease has potentially important diagnostic and therapeutic implications. Oral KS (OKS) most often affects the hard and soft palate, gingiva, and dorsal tongue with plaques or tumors of coloration ranging from non-pigmented to brownish-red or violaceous. Its involvement ranges from an incidental finding to proliferative tumor formation that interferes with mastication. OKS needs to be distinguished clinically from other entities, including pyogenic granuloma, hemangioma, bacillary angiomatosis, and gingival enlargement caused by cyclosporine, a drug frequently used in recipients of organ transplantation. KS may flare as part of the immune reconstitution inflammatory syndrome in HIV patients or develop in the context of iatrogenic immunosuppression. Management, which may depend upon a variety of factors including the clinicopathologic type of KS and results of staging, ranges from no treatment to local measures such as intralesional vinblastine or systemic administration of cytotoxic chemotherapy for disseminated disease. Modification of immunosuppressive regimens often helps control post-transplant OKS but enhances the risk of graft rejection. Screening donors and recipients of organ transplants for HHV-8, with prophylactic treatment if infected as well as institution of sirolimus early after transplantation, are proposed strategies aimed at preventing post-transplant OKS.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Oral Kaposi's sarcoma: a review and update

Fatahzadeh

Schwartz

2013

Int J Dermatology

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“…However, in the renal transplant setting, the use of IFN therapy has produced unsatisfactory results. Not only are these therapies less effective, but they are also associated with increased risks of acute renal insufficiency and graft rejection [16], [17]. So, physicians managing RT recipients must balance the benefits of reducing HCV infection and subsequent hepatic disease with the complications from antiviral therapy.…”

Section: Introductionmentioning

confidence: 99%

“…IFN-RIB/PEG-RIB) [29]–[32]. In particular, PEG-based therapies appear to have fewer side effects, better antiviral efficacy, and more rapidly viral clearance than the standard IFN therapy in most patients [16]. Since earlier meta-analyses did not include PEG-based therapy or combination therapy, an updated meta-analysis is necessary to evaluate IFN-based therapy more appropriately in post-RT patients.…”

Section: Introductionmentioning

confidence: 99%

Interferon-Based Anti-Viral Therapy for Hepatitis C Virus Infection after Renal Transplantation: An Updated Meta-Analysis

Fang

Liu

et al. 2014

PLoS ONE

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BackgroundHepatitis C virus (HCV) infection is highly prevalent in renal transplant (RT) recipients. Currently, interferon-based (IFN-based) antiviral therapies are the standard approach to control HCV infection. In a post-transplantation setting, however, IFN-based therapies appear to have limited efficacy and their use remains controversial. The present study aimed to evaluate the efficacy and safety of IFN-based therapies for HCV infection post RT.MethodsWe searched Pubmed, Embase, Web of Knowledge, and The Cochrane Library (1997–2013) for clinical trials in which transplant patients were given Interferon (IFN), pegylated interferon (PEG), interferon plus ribavirin (IFN–RIB), or pegylated interferon plus ribavirin (PEG–RIB). The Sustained Virological Response (SVR) and/or drop-out rates were the primary outcomes. Summary estimates were calculated using the random-effects model of DerSimonian and Laird, with heterogeneity and sensitivity analysis.ResultsWe identified 12 clinical trials (140 patients in total). The summary estimate for SVR rate, drop-out rate and graft rejection rate was 26.6% (95%CI, 15.0–38.1%), 21.1% (95% CI, 10.9–31.2%) and 4% (95%CI: 0.8%–7.1%), respectively. The overall SVR rate in PEG-based and standard IFN-based therapy was 40.6% (24/59) and 20.9% (17/81), respectively. The most frequent side-effect requiring discontinuation of treatment was graft dysfunction (14 cases, 45.1%). Meta-regression analysis showed the covariates included contribute to the heterogeneity in the SVR logit rate, but not in the drop-out logit rate. The sensitivity analyses by the random model yielded very similar results to the fixed-effects model.ConclusionsIFN-based therapy for HCV infection post RT has poor efficacy and limited safety. PEG-based therapy is a more effective approach for treating HCV infection post-RT than standard IFN-based therapy. Future research is required to develop novel strategies to improve therapeutic efficacy and tolerability, and reduce the liver-related morbidity and mortality in this important patient population.

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“…Viral reactivation following transplant can be associated with serious ramifications, such as allograft rejection and dysfunction (Table ) . An immunosuppressant providing effective protection against rejection coupled with a reduced risk of viral reactivation is an attractive proposition indeed.…”

Section: Introductionmentioning

confidence: 99%

Effect of maintenance immunosuppressive drugs on virus pathobiology: evidence and potential mechanisms

Brennan

Aguado

Potena

et al. 2012

Reviews in Medical Virology

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Recent evidence suggesting a potential anti-CMV effect of mTORis is of great interest to the transplant community. However, the concept of an immunosuppressant with antiviral properties is not new, with many accounts of the antiviral properties of several agents over the years. Despite these reports, to date, there has been little effort to collate the evidence into a fuller picture. This manuscript was developed to gather the evidence of antiviral activity of the agents that comprise a typical immunosuppressive regimen against viruses that commonly reactivate following transplant (HHV1 and 2, VZV, EBV, CMV and HHV6, 7, and 8, HCV, HBV, BKV, HIV, HPV, and parvovirus). Appropriate immunosuppressive regimens posttransplant that avoid acute rejection while reducing risk of viral reactivation are also reviewed. The existing literature was disparate in nature, although indicating a possible stimulatory effect of tacrolimus on BKV, potentiation of viral reactivation by steroids, and a potential advantage of mammalian target of rapamycin (mTOR) inhibition in several viral infections, including BKV, HPV, and several herpesviruses.

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Treatment issues surrounding hepatitis C in renal transplantation: A review

Cited by 22 publications

References 81 publications

Oral Kaposi's sarcoma: a review and update

Oral Kaposi's sarcoma: a review and update

Interferon-Based Anti-Viral Therapy for Hepatitis C Virus Infection after Renal Transplantation: An Updated Meta-Analysis

Effect of maintenance immunosuppressive drugs on virus pathobiology: evidence and potential mechanisms

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