Histopathologic efficacy of ribavirin monotherapy in kidney allograft recipients with chronic hepatitis C

Background. The deterioration of chronic hepatitis C is frequent in kidney recipients and results in a decrease in survival of patients and allografts. Interferon is contraindicated because of the risk of rejection and its low efficacy. The aim of this study was to analyze the biologic, virologic, and histopathologic efficacy of ribavirin alone in kidney allograft recipients with hepatitis C. Methods. Thirteen kidney recipients (eight men and five women, 46 +/- 11 years of age) with severe Metavir score of fibrosis (eight F3 and five F4) were treated with ribavirin alone during 22.4 +/- 13.9 months. Liver biopsy was performed before and during therapy, with a mean interval time of 5.7 +/- 9.3 years. Results. The transaminase level decreased significantly (128 +/- 77 vs. 53 +/- 28, P=0.001) without significant change of serum quantitative hepatitis C virus load. The comparison of pretreatment and on-treatment biopsy specimens showed a significant decrease in the activity Metavir score (1.23 +/- 1.01 vs. 2.46 +/- 0.78, P= 0.05) and a nonsignificant trend for a decrease in the fibrosis score. Ribavirin tolerance was fair, and only one patient required erythropoietin therapy. Conclusions. Ribavirin alone in kidney allograft recipients results in biologic and histologic improvement without a virologic response and is reasonably well tolerated.