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http://www.medscape.com/
Posted 04/04/2003
Question
A
45-year-old female patient received a
living-related kidney transplant. Prior to
surgery, her screening for hepatitis C virus (Hepatitis C Virus)
was negative; posttransplantation ELISA for Hepatitis C Virus
and polymerase chain reaction (PCR) quantitative
screening (5 million copies) demonstrate acute
hepatitis with severe hypertransaminasemia (in the
range of 3000 mg/dL). What is your recommendation
for treatment?
Hugo Páez, MD
Response
from Roshan Shrestha, MD, 04/04/2003
This
is a very interesting question. This patient is
the classic patient with acute hepatitis due to
Hepatitis C Virus infection. The most important thing we need to
know is the timing. It looks as if she clearly was
negative before transplantation and now is
positive by both virologic and enzymatic
evaluation; therefore, she meets the criteria for
acute hepatitis. If she has evidence of hepatitis
for at least 6 months and hasn't cleared the virus
spontaneously (occurs in at least 50% of acute
hepatitis C cases), then she should be considered
for treatment with interferon (IFN) and ribavirin.
There is not much data on pegylated IFN, but I
would imagine the efficacy of this agent would be
even better. In the literature on IFN-alpha-2b,
the response rate is very high (> 95%) in this
setting.[1]
Therefore, I would recommend treatment with a
combination of pegylated IFN and ribavirin for 4
months if the patient is a candidate, with the
hope that she will respond. At the same time,
there is evidence that antiviral therapy may
exacerbate acute cellular graft rejection;
therefore, graft function should be monitored very
closely.
References
- Jaeckel
E, Cornberg M, Wedemeyer H; German Acute
Hepatitis C Therapy Group. Treatment of acute
hepatitis C with interferon alfa-2b. N Engl J
Med. 2001;345:1452-1457.
About the Panel Members
Roshan Shrestha, MD, Assistant Professor of
Medicine, Associate Director of Transplant
Hepatology, Medical Director, Liver
Transplantation Program University of North
Carolina, Chapel Hill, NC.
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