In patients infected with HCV who have end-stage renal disease, patient survival is significantly better with kidney transplantation compared to remaining on hemodialysis. However, HCV infection has a detrimental effect on survival after kidney transplantation.1 Unfortunately, interferon-based therapy is not recommended after renal transplantation because of the risk of acute rejection and graft dysfunction. Therefore, eradication of this virus should be actively pursued before transplantation. Preliminary data support the efficacy of interferon-based therapy in this setting, but the experience with pegylated interferon formulations is still limited, and it is still unclear whether there are differences between the two pegylated interferons.2
Although ribavirin is usually not recommended in these patients because the drug is not removed during conventional dialysis and its accumulation causes a dose-dependent hemolytic anemia, recent promising data involve the combination of pegylated interferon and reduced dose of ribavirin with ribavirin plasma concentration monitoring. The data though are still limited to a few studies that include small sample sizes.3, 4 We therefore fully agree with Dr. Casanova that there is a need for additional research, particularly controlled clinical studies to assess the potential benefits of adding ribavirin, the potential differences of the two pegylated interferons, as well as analyzing the impact of the dialysis technique on treatment outcome.