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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#58;</p><p class="elsevierStylePara">The prevalence of chronic infection due to the hepatitis C virus in kidney transplant patients ranges from 5 to 40&#37;&#46;<span class="elsevierStyleSup">1</span> Hepatitis C increases the morbimortality in both haemodialysis and kidney transplant patients&#46; Hepatitis C should be treated prior to transplant&#44; since post-transplant treatment with interferon-alpha<span class="elsevierStyleSup">2</span> increases the risk of acute humoral rejection&#44; particularly during the immediate post-transplant phase&#46;</p><p class="elsevierStylePara">We present the case of a 55 year old male with a history of chronic terminal renal failure secondary to mesangial glomerulonephritis IgA&#44; who began haemodialysis in October 1989&#44; arterial hypertension and chronic infection due to hepatitis C virus &#40;genotype 1&#41;&#46; The patient received a cadaver kidney transplant in 1997 and began immunosuppressant therapy with OKT3&#44; corticosteroids and cyclosporine&#46; Development following the renal transplant was without incident&#44; with stable renal function &#40;urea 45mg&#47;dL&#44; Cr 0&#46;8mg&#47;dL&#41;&#44; negative proteinuria&#44; chronically elevated transaminases&#44; positive RNA-HCV with no evident clinical signs of cirrhosis or advanced hepatopathy&#44; and cyclosporine levels within the therapeutic range&#46; The patient regularly attended digestive reviews&#44; where it was decided to recommend treatment with interferon-alpha and ribavirin for twelve months&#46; His renal function remained stable during this period&#46; Three months following completion of the treatment&#44; renal function deteriorated with 133mg&#47;dL urea&#44; 1&#46;8mg&#47;dL Cr and 1&#46;8g&#47;24h proteinuria&#44; which worsened with later tests &#40;urea 203mg&#47;dL and Cr 2&#46;7mg&#47;dL&#41;&#46; Ig and cryglobulin levels and an autoimmune study were all normal&#46; It was decided to admit the patient in order to perform a diagnostic renal biopsy&#46; The differential diagnosis included relapse of mesangial glomerulonephritis IgA&#44; membranous or mesangiocapillary glomerulonephritis caused by the hepatitis C virus&#44; chronic graft nephropathy or acute secondary rejection on treatment of interferon&#46; The renal biopsy revealed acute humoral rejection with C4d&#43;&#44; and Ab anti-HLA levels were positive &#40;22&#37;&#41; against the donor&#46; It was decided to begin treatment with three 25 0mg 6-methylprednisolone tablets and conversion to tacrolimus&#46; The response to treatment was good&#44; with an improvement of renal function&#58; 150mg&#47;dLurea&#44; 2mg&#47;dL CR and a reasonable decrease in proteinuria &#40;1&#46;2g&#47;24h&#41;&#46;</p><p class="elsevierStylePara">The optimum treatment for hepatitis C in renal transplant patients today is controversial&#46; Use of interferon is not advised&#44; since it increases the chance of episodes of acute humoral rejection &#40;15-64&#37;&#41; three to six months after beginning treatment&#44;<span class="elsevierStyleSup">3</span> and its use is indicated only in patients with fibrosing cholestatic hepatitis&#44; where there is a significantly increased morbimortality&#46; The incidence of acute humoral rejection is lower in patients with long-developing transplants&#44; owing to immunological accommodation&#46; The mechanism for inducing acute rejection is unclear&#44; but it is thought that the drug increases the release of HLA antigens in the cellular surface and induces the release of cytokines&#44; consequently stimulating the production of antibodies&#46;<span class="elsevierStyleSup">4</span> To minimise the risk of rejection&#44; patients should have stable immunosuppression and should be closely monitored&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">The case in question concerns a patient ith a normally functioning kidney transplant and stable renal function who received&#44; twelve years after transplant&#44; treatment with ribavirin and interferon-alpha&#44; with a subsequent episode of humoral rejection&#46; The importance of this case lies in the fact that the acute humoral rejection appeared during the late post-transplant period&#44; and three months after having completed interferon treatment&#44; which is uncommon&#46;</p><p class="elsevierStylePara">In conclusion&#44; it is of vital importance that nephrologists and digestive specialists know the indications of interferon in the transplant population&#44; weighing up its potential benefits against the risk of rejection&#44; and ensure patients on antiretroviral treatment are more closely monitored&#44; even once this treatment has ended&#46; Safer and more effective treatments are needed for treating renal transplant patients with infection from the hepatitis C virus&#46;</p>"
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Interferon-alpha and its deleterious effects on kidney transplant: regarding one case
EL INTERFERÓN ALFA Y SUS EFECTOS DELETÉREOS EN EL TRASPLANTE RENAL: A PROPÓSITO DE UN CASO.
Pilar Frailea, P. García-Cosmesa, C. Rosadoa, J.M.. Taberneroa
a Servicio de Nefrología, Hospital Universitario de Salamanca Salamanca, Salamanca, España,
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Idiomas
Nefrología (English Edition)