Interferon-α/peginterferon-α-2a

Reactions 1196 - 5 Apr 2008 S Interferon-α/peginterferon-α-2a Acute allograft rejection in kidney transplant recipients with failed allografts: 4 case reports Four patients with failed allografts developed acute kidney allograft rejection during treatment with peginterferon-α-2a (patient 1) or interferon-α (patients 2–4) for chronic hepatitis C infection [patient outcomes not stated]. Patient 1, a 32-year-old man, underwent a second allograft and, despite immunosuppression, developed chronic allograft nephropathy, followed by end-stage renal failure (ESRF). Immunosuppression was withdrawn with the exception of low-dose prednisone. A liver biopsy revealed a Metavir score of A1F2 and, in September 2005, he started receiving SC peginterferon-α-2a [Pegasys] 135 µg/week. Two months later, he developed gross haematuria, mild inflammatory syndrome and a painful transplant. He underwent transplantectomy and histological examination revealed chronic allograft lesions, diffuse interstitial haemorrhage and diffuse interstitial infiltration by plasmocytes, lymphocytes and arterial thrombi. Patient 2, a 28-year-old man, who had undergone kidney allograft transplantation, developed chronic allograft dysfunction, followed by ESRF. Immunosuppression was discontinued with the exception of low-dose prednisone. Two months later, his ALT levels were persistently elevated and he started receiving interferon-α 3 million units, three times a week. After 75 days, he developed a fever (40°C), pain in his allograft and haematuria. He had a C-reactive protein level of 328 mg/L and new-onset anaemia (9.7 g/dL). He underwent transplantectomy and histological findings supported acute humoral rejection on chronic rejection. Patient 3, a 32-year-old man, underwent a second transplant and developed chronic allograft nephropathy, which was possibly related to hepatitis C virus infection. Immunosuppression was withdrawn with the exception of low-dose prednisone. A liver biopsy revealed a Metavir score of A2F2 and he started receiving interferon-α 3 million units, three times a week. After 12 months, he presented with gross haematuria, mild fever and pain in his allograft. He underwent transplantectomy, which revealed acute rejection on chronic lesions. Patient 4, a 57-year-old man, underwent a second kidney transplant and subsequently developed chronic active hepatitis. He started receiving interferon-α 3 million units, three times a week. Despite immunosuppression, he developed acute cellular and vascular rejection and received methylprednisolone pulses with a partial response. Interferon- α was withdrawn, but he developed ESRF. A liver biopsy revealed chronic active hepatitis and interferon-α was reinitiated at the same dosage. Three weeks later, he presented with fever (39°C), a decreased haemoglobin level (9.5 g/dL), an elevated C-reactive protein level (173 mg/dL) and a painful graft. He underwent transplantectomy, which revealed capillaritis lesions, chronic rejection lesions and interstitial oedema. W´ eclawiack H, et al. Alpha-interferon therapy for chronic hepatitis C may induce acute allograft rejection in kidney transplant patients with failed allografts. Nephrology Dialysis Transplantation 23: 1043-1047, No. 3, Mar 2008 - France 801105365 1 Reactions 5 Apr 2008 No. 1196 0114-9954/10/1196-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Transcript of Interferon-α/peginterferon-α-2a

Reactions 1196 - 5 Apr 2008

SInterferon-α/peginterferon-α-2a

Acute allograft rejection in kidney transplantrecipients with failed allografts: 4 case reports

Four patients with failed allografts developed acute kidneyallograft rejection during treatment with peginterferon-α-2a(patient 1) or interferon-α (patients 2–4) for chronic hepatitis Cinfection [patient outcomes not stated].

Patient 1, a 32-year-old man, underwent a second allograftand, despite immunosuppression, developed chronic allograftnephropathy, followed by end-stage renal failure (ESRF).Immunosuppression was withdrawn with the exception oflow-dose prednisone. A liver biopsy revealed a Metavir scoreof A1F2 and, in September 2005, he started receiving SCpeginterferon-α-2a [Pegasys] 135 µg/week. Two months later,he developed gross haematuria, mild inflammatory syndromeand a painful transplant. He underwent transplantectomy andhistological examination revealed chronic allograft lesions,diffuse interstitial haemorrhage and diffuse interstitialinfiltration by plasmocytes, lymphocytes and arterial thrombi.

Patient 2, a 28-year-old man, who had undergone kidneyallograft transplantation, developed chronic allograftdysfunction, followed by ESRF. Immunosuppression wasdiscontinued with the exception of low-dose prednisone. Twomonths later, his ALT levels were persistently elevated and hestarted receiving interferon-α 3 million units, three times aweek. After 75 days, he developed a fever (40°C), pain in hisallograft and haematuria. He had a C-reactive protein level of328 mg/L and new-onset anaemia (9.7 g/dL). He underwenttransplantectomy and histological findings supported acutehumoral rejection on chronic rejection.

Patient 3, a 32-year-old man, underwent a second transplantand developed chronic allograft nephropathy, which waspossibly related to hepatitis C virus infection.Immunosuppression was withdrawn with the exception oflow-dose prednisone. A liver biopsy revealed a Metavir scoreof A2F2 and he started receiving interferon-α 3 million units,three times a week. After 12 months, he presented with grosshaematuria, mild fever and pain in his allograft. He underwenttransplantectomy, which revealed acute rejection on chroniclesions.

Patient 4, a 57-year-old man, underwent a second kidneytransplant and subsequently developed chronic activehepatitis. He started receiving interferon-α 3 million units,three times a week. Despite immunosuppression, hedeveloped acute cellular and vascular rejection and receivedmethylprednisolone pulses with a partial response. Interferon-α was withdrawn, but he developed ESRF. A liver biopsyrevealed chronic active hepatitis and interferon-α wasreinitiated at the same dosage. Three weeks later, he presentedwith fever (39°C), a decreased haemoglobin level (9.5 g/dL), anelevated C-reactive protein level (173 mg/dL) and a painfulgraft. He underwent transplantectomy, which revealedcapillaritis lesions, chronic rejection lesions and interstitialoedema.Weclawiack H, et al. Alpha-interferon therapy for chronic hepatitis C may induceacute allograft rejection in kidney transplant patients with failed allografts.Nephrology Dialysis Transplantation 23: 1043-1047, No. 3, Mar 2008 -France 801105365