Başkent Üniversitesi Makaleler

Permanent URI for this collectionhttps://hdl.handle.net/11727/13096

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Subject: search.filters.subject.Interferon

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    Aggressive Use of Ribavirin and Prolonged Course of Peginterferon to Improve the Rate of Viral Response in Liver Transplant Patients with Recurrent Hepatitis C Viral Infection
    (Başkent Üniversitesi, 2010-09) Singhal, Aaditya; Black, Martin; Burke, Monika; Jain, Ashokkumar B.
    Objectives: There are different approaches for treating recurrent hepatitis C viral infection after a liver transplant. However, sustained virologic response is achieved in < 40% of infected allografts. We examined sustained virologic response improvement using a prolonged course of peginterferon and aggressive use of ribavirin. Patients and Methods: From October 1998 to May 2008, 24 patients (13 male, 11 female; mean age at transplant, 49.4 ± 7.7 years) received a prolonged course of peginterferon and ribavirin (range, 48-180 weeks). The mean interval from liver transplant to hepatitis C antiviral therapy was 26.6 ± 27.8 months. Patients began weight-based standard dosages of peginterferon and ribavirin. In case of hemolysis, patients were treated with Epogen, with and without blood transfusions. Results: Fourteen patients (58.3%) had an end of treatment response, and 8 patients (33.3%) maintained sustained virologic response after the first course of therapy. Of 10 patients who did not respond to the first course, 6 received an extended course of antiviral therapy after a mean of 15 ± 4.6 weeks from completion of first course. Five of these 6 patients achieved end of treatment response and maintained a sustained virologic response, resulting in an overall end of treatment response in 17 patients and a sustained virologic response in 13 patients. Twenty-two patients experienced hemolysis and were treated with Epogen. Fifteen patients received blood transfusions. Ribavirin dosage was reduced in 12 patients, and peginterferon dosage was reduced in 2 patients. Conclusions: Aggressive use of ribavirin and prolonged course of peginterferon provided sustained virologic response in 54.1% of liver transplant recipients with recurrent hepatitis C virus-infection. More prospective studies are warranted to evaluate the benefit of this approach fully.
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    An International Survey of the Diagnosis, Management, and Treatment of Hepatitis C in Patients with End-Stage Renal Disease
    (Başkent Üniversitesi, 2009-12) Araya, Victor; Ortiz, Jorge; Olson, Mira R.; Grewal, Kevin S.; Bingaman, Adam; Zaki, Radi; Stewart, Shelby; Horton, John
    Objectives: Hepatitis C is one of the leading causes of death from liver disease in the United States, and is frequently associated with renal disease. Two major organizations—the American Association for the Study of Liver Disease and the National Kidney Foundation—have published recommendations regarding the treatment of hepatitis C in the presence of chronic kidney disease; however, these guidelines do not always provide the same recommendations. Given the paucity of data on adherence to the current guidelines, a survey was conducted to provide information about the current practices of physicians in comparison to the published guidelines. Materials and Methods: An observational study was conducted via a global survey asking physicians treating patients who had concurrent hepatitis C and chronic kidney disease. Results: The 218 questionnaires collected requested the physician’s subspecialty, the number of transplants performed at the hospital, the usual method of screening for hepatitis C, the preferred route, the indication and frequency of liver biopsy, the use of ribavirin and interferon, the use of hepatitis-C–positive donors in kidney transplant, and consent requirements. Conclusions: Our results showed that many physicians do not follow current recommendations. We argue that a consensus group be formed to set forth guidelines for the management of hepatitis C to optimize outcomes, and improve overall morbidity.
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    Impact of Hepatitis C Virus Infection on Short-Term Outcomes in Renal Transplantation
    (Başkent Üniversitesi, 2004-12) Broumand, Behrooz; Hakemi, Monir Sadat; Sabet, Maryam Shafiei
    Hepatitis C virus is an RNA virus with 6 known genotypes. Prevalence of hepatitis C virus infection in the world is almost 3%. In patients undergoing hemodialysis, prevalence of hepatitis C virus positivity is reported to be from 1%-54% depending on the methods used for detection. Liver disease in kidney transplant recipients has been attributed to hepatitis B virus, hepatitis C virus, Epstein-Barr virus, cytomegalovirus, ethanol, hemosiderosis, and drugs such as azathioprine and cyclosporine A. Hepatitis C virus infection is currently the maincause of chronic liver disease in this group, and it may affect allograft outcome. Whether hepatitis C virus infection after renal transplantation adversely affects graft and patient survival remains controversial. Several series have reported no impact on short- and long-term patient and graft survival. In fact, comparative studies using different immunosuppressive protocols are not available. The differences in the results of these studies may be explained by confounding factors, for example, differences in immunosuppressive protocols, study design, methodology of diagnosing hepatitis C virus infection, and differences in hepatitis C virus genotypes. Treatment protocols for hepatitis-C-virus–associated liver disease should be considered before renal transplantation. Nevertheless, transplantation is the best option for patients with hepatitis C virus with end-stage renal disease, and less hepatotoxic immunosuppressive agents may decrease the incidence of posttransplant liver disease in patients with hepatitis C virus. This review will discuss the studies with specific emphasis on the impact of hepatitis C virus infection on short-term outcome in renal transplantation