Page 1 of 1: hepatitis in renal transplant

manpreet108 · Credits: 30702 My Scrapbook

treatment of hepatitis C in post transplant pt is -
ribavirin alone
ribavarin + interferon
3.interferon alone
4.no treatment.

pls comment with ref.

guest · Credits: 79379 My Scrapbook My Reading List 262569 Books

It is both interferon and ribavirin. For reference an article from medscape is quoted.

"Liver Transplant Patients
End stage liver disease caused by chronic hepatitis C is now the major indication for liver transplantation in Europe and North America. With no active intervention graft reinfection is inevitable and, in the setting of the anti-rejection therapy, rapidly progressive disease can occur threatening graft and patient survival.

Pretransplant
Ideally the physician should aim for a sustained viral clearance before transplant but this is rarely feasible as the patients frequently have decompensated disease and, in patients with HCC, the urgent need for transplant limits the use of effective antiviral therapy prior to the procedure.

With careful supervision and dose modification some patients can benefit with pretransplant treatment.

Post-transplant
Despite the immunostimulatory effects of IFN alfa and the theoretical risks of graft rejection, IFN is successfully used in many recipients of liver transplants. Most of the published studies have featured trials of standard IFN and ribavirin and there is increasing use of PEG-IFN with ribavirin. Overall the success rates are lower in the post-transplant patients and discontinuation rates much higher than is seen in the nontransplant setting.

In one French study, 52 liver transplant recipients were randomized to receive standard IFN in combination with IFN or placebo. The SVR was 21% in those who received the combination and 0% in those who received placebo. Significant side-effects, particularly severe anaemia, led to treatment discontinuation in 43%.

Another study compared 6 months vs 12 months of IFN and ribavirin. Fifty-seven patients (68% genotype 1b) were treated and the SVR was 22% in those who received 6 months of therapy and 17% in those who received 1 year of therapy suggesting that a subgroup of patients may benefit from a relatively short course of treatment. This study also demonstrated that in the virological nonresponders with a biochemical response there was also histological improvement and there may be a role for 'maintenance therapy' in this group of patients.

In view of the poor tolerance of antiviral regimens and the low antiviral response in this group other approaches have been tried such as ribavirin monotherapy. Short-term use of ribavirin monotherapy has been shown lead to a biochemical response and a decrease in the inflammatory score on liver histology but longer term follow up will be required to ascertain whether this is also associated with a reduction in fibrosis development.

Most studies now feature PEG-IFN and ribavirin. One pilot study described high levels of discontinuation because of side-effects (43.6%) but an SVR of 66.7% in those who completed therapy.

For those patients unable to tolerate IFN and ribavirin there are prospects of future therapy with protease and helicase inhibitors or alternative approaches with anti-fibrotic rather than antiviral agents."

decembermist · Credits: 41211 My Scrapbook

In CMDT 2005, pg no: 641,Its given

IF are contraindicated in Heart,Lung & Renal transplant patients cos of increase risk of rejection

Selected liver transplant recepients with r/c hep C may b Rxed with Peginterferon + ribavarin -- bt response rates are low.

Manu wats the ans given ??

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