Creatinine went up to they 215 ��mol/L, 12 wk after starting therapy. The patient showed a virological response and since the nephropathy was not related to interferon it was decided to continue a full course of treatment. The third patient had only a mild elevation of serum creatinine from 168 ��mol/L before treatment to 199 ��mol/L at the end of treatment; however, he also underwent a kidney biopsy before starting treatment and has shown MPGN, which has no contraindication to treatment, and indeed if HCV related, may respond well to antiviral therapy. These three patients who developed abnormal renal function and underwent kidney biopsies had an excellent ETR and 2 of them had SVR at 24 wk post therapy.
There was no significant change in GFR during or after therapy from baseline except in the only patient who had rejection who had a decrease in GFR from 61 mL/min to 38 mL/min at the end of therapy. Serum creatinine and GFR remained stable during the treatment period (Table (Table11). Impact of type of immunosuppression There was no relation observed between response rate and the type of immunosuppression regimen used during therapy. There was no relation between the increase of creatinine or decrease in GFR rate and the type of immunosuppression regimen used. Impact of gender, duration post transplant and age on the parameters at the end of therapy period Stratification by gender, duration post transplant and age had no impact on the final post transplant levels of the parameters measured (Tables (Tables3,3, ,4,4, and and55).
Table 3 Impact of patient gender on the parameters at the end of therapy Table 4 Impact of duration post transplant on the parameters at the end of therapy Table 5 Impact of age on the parameters at the end of therapy Table Table66 summarises recent reports on the efficacy and rejection rate following the use of interferon in post renal transplant HCV infection. It shows that there is a high rate of response to PEG-IFN especially when it is combined with ribavirin, compared to conventional interferon. Furthermore, the rate of rejection and graft failure with this type of therapy is much lower than that with conventional interferon (Table (Table66). Table 6 Summary of some reports on the efficacy and rejection rate following the use of interferon alone or in combination with ribavirin in post renal transplant hepatitis C virus infection DISCUSSION Several studies have shown a negative impact of HCV on patient and graft survival post renal transplantation[12-15,19,25,26].
Immunosuppressive therapy after renal transplantation usually leads to a flare up of HCV viremia. In the setting of renal and other organ transplantation, HCV infected post transplant patients have an aggressive and rapidly GSK-3 progressive liver disease with cirrhosis, liver failure and death[12,22,23,36,37].