Hepatitis C Virus Eradication in Kidney Transplant Recipients: A Single-Center Experience in Portugal.

INTRODUCTION: Hepatitis C (HCV) is a major cause of liver impairment post-kidney transplantation (KT). Anti-HCV direct-acting antivirals (DAA) made viral eradication possible. METHODS: We performed a retrospective review of KT patients (n = 23) who received DAA at our hospital. Sustained viral response (SVR) was defined as absence of viral detection 12 weeks after cessation of therapy. RESULTS: From 1985 to September 2017, 1440 patients underwent transplantation at Hospital Santa Cruz. From a total of 32 HCV RNA+ KT recipients on follow-up, we describe the first 23 patients treated with DAA. They were 56.7 ± 9.1 years old; 22 were white, 52.2% were males, they underwent transplantation 18.8 ± 9.0 years ago, and 13 had genotype 1B, 21 were naïve, and 9 had stages F3/F4. All but 2 patients, treated with grazoprevir/elbasvir, received sofosbuvir (18 with ledispasvir, 2 with daclastavir, and 4 with simultaneous ribavirin). Pretreatment, intra-treatment, and post-treatment creatinine clearances were 61.4, 60.6, and 60.7 mL/min/1.73 m2, respectively (not significant [NS]). Cyclosporine A was the basis of immunosuppression in the majority [(n = 14); pretreatment and intra-treatment levels were 79.5 ± 23.0 and 91.8 ± 26.0 ng/mL, respectively (P = .08)]; tacrolimus (n = 8) and mammalian target of rapamycin (mTOR) levels (n = 5) were also similar. One patient interrupted ribavirin after 7 weeks due to anemia; all other patients completed the treatment course without major side effects. Only 3 patients presented positive viral RNA at the fourth week of treatment and SVR was achieved in 100% of the patients 12 weeks after treatment. CONCLUSIONS: DAA therapy was well tolerated and effective in 100% of our treated patients, without significant impact on the renal function or on the immunosuppression.

Lack of impact of hepatitis C virus infection on graft survival after kidney transplantation--a Portuguese single-center experience.

BACKGROUND: Hepatitis C virus infection (HCV) is a common problem among kidney transplant (KT) recipients. The long-term burden of HCV infection on graft survival after kidney transplantation is controversial. METHODS: We performed a retrospective study including all renal transplant recipients with HCV infection (n = 34) compared with a control group (n = 80). The prevalence of HCV infection was 2.7%. The median follow-up period was 134 months (11 years). Graft survival and associated risk factors were assessed by means of Cox proportional hazard analysis. RESULTS: We found that HCV-positive patients remained on dialysis for longer periods (P = .001) and received transplants at a younger age (P = .03). Actuarial graft survival rates at 1, 5, and 10 years after KT were, respectively, 94.1%, 78.1%, and 66.9%, in the HCV-positive group and 94.9%, 89.1%, and 80.4% in the HCV-negative group. Graft survival did not differ significantly between groups (P = .154). A higher incidence of major cardiovascular disease among HCV-positive patients (P = .004) was noted. Multivariate analysis showed that HCV infection was not an important risk factor for graft loss (adjusted hazard ratio, 2.810; 95% confidence interval, 0.925-8.541; P = .069). Among the HCV-positive population, immunosuppression with cyclosporine or azathioprine conveyed better graft survival. CONCLUSIONS: Our findings suggest that the long-term impact of HCV infection on graft survival after KT is not significant. KT remains a safe and effective modality of renal replacement in HCV-infected patients with end-stage renal disease.

[Essential thrombocythemia. Therapy with interferon alfa]. / Trombocitemia essencial. Terapêutica com alfa interferão.

A clinical case of essential thrombocythaemia is presented to demonstrate good therapeutic response to subcutaneous Alpha-2b Interferon in a dosage of 3 x 10(6) units, three times a week. Based on this case and on a literature research we propose that Alpha-2b Interferon is a legitimate alternative to alkylating agents or radioactive phosphorus (32P), showing identical efficacy and less Leukemogen effect.

[Cyclosporin A--a therapeutic alternative in giant-cell arteritis?]. / Ciclosporina A--alternativa terapêutica na arterite de células gigantes?

Cyclosporine A (CyA) is an immune modulator that may treat immune diseases. The authors present two cases of temporal arteritis treated with CyA; the two patients improved very quickly and after the first six or eight weeks of treatment there were no clinical or laboratory signs of inflammation. As to adverse effects there was a moderate increase in serum creatinine and arterial pressure levels which were controlled when the CyA dosage was reduced. In view of the good results achieved in these two patients, the authors concluded that CyA may be an alternative therapy for giant-cell arteritis and that this hypothesis should be further investigated in a larger group of patients.