Nefrologia 2014;34(6):676
doi:10.3265/Nefrologia.pre2010.Jun.10485
Reply to Martín-Gómez MA
Comment on Nefrologia 2014;34(6):675
Nefrologia 2014;34(2):230-4
Nefrologia 2014;34(6):676
doi:10.3265/Nefrologia.pre2014.Jun.12599
Respuesta a Martín-Gómez MA
Comentario en Nefrologia 2014;34(6):675
Nefrologia 2014;34(2):230-4
To the Editor,
We appreciate the comments made by Dr. Martin-Gómez1 on our article “Acute rejection of non-functional renal graft in dialysis patients after starting treatment with interferon and ribavirin”. As the author notes, treatment with ribavirin (RBV) worsens anaemia in patients with chronic kidney disease, even in those with a prior kidney transplant with immunological intolerance syndrome or, as in the cases presented in our article, acute rejection after initiation of antiviral therapy with interferon (IFN), as a result of the intense inflammatory reaction triggered. Consequently, nephrologists should always pay special attention to these patients with more frequent laboratory controls, more intense treatment with erythropoietin stimulating factors and/or iron therapy and in refractory cases, blood transfusion, which, as Dr. Martín-Gómez says in her letter, could jeopardise the future of a new transplantation due to the formation of anti-HLA antibodies.
Currently, new direct acting antiviral drugs are being tested2, some of which are already used in patients without kidney disease that have not responded to standard therapy, increasing response rate3. Telaprevir and boceprevir, NS3/4A protease inhibitors, have already been approved as antiviral salvage therapy in patients with chronic hepatitis C, genotype 1, and are being tested in clinical trials with patients with chronic terminal kidney disease4; although in the case we are addressing they would not provide any benefit, as they are administered in triple therapy with IFN and RBV, and also cause anaemia, among other side effects2,3. However, at present there are other ongoing clinical trials with new molecules such as MK-5172, an NS3/4A protease inhibitor and MK-8742, an NS5A replication complex inhibitor, which would be free of IFN and RBV and could be an interesting alternative. However, solid organ transplant recipients have, to date, b>>een excluded from these5.
Until we have the results of these clinical trials and patients with non-functioning kidney transplants participate in them, we will have to take the measures detailed in these articles1,6.
Conflicts of interest
The authors declare that they have no conflicts of interest related to the contents of this article.
