Iron Overload in Renal Transplant Patients: The Role of Hepcidin and Erythropoietin.

Renal transplant patients may present important serum iron overload (IO), which can persist for long periods after transplantation, but its mechanisms are not fully understood. We raised the hypothesis that post-transplant hypererythropoietinemia might induce reduction in serum hepcidin, favoring iron absorption. The aims of this study were to determine the prevalence of IO and associated factors in transplant patients and to evaluate erythropoietin and hepcidin levels in patients with and without IO. A total of 168 patients were included, with a median time of dialysis and transplantation of 28 and 65 months, respectively. Most patients (85%) received large amounts of parenteral iron (3600 mg iron) during the dialysis period. Median ferritin was 427 ng/mL, and transferrin saturation was 33%. IO was present in 26 patients (15%). A comparison of patients with and without IO showed a predominance of male and nonwhite patients in the former group (P < .001 and .002, respectively). The total amount of iron used before transplantation and hemoglobin levels were higher in the group with IO (P = .023 and .046, respectively). Hepcidin was higher in the group with IO (P < .0001), whereas erythropoietin did not differ between groups. There was no correlation between serum levels of hepcidin and erythropoietin (r = -0.001). In conclusion, factors associated with IO were male sex, higher hemoglobin levels, and the amount of iron received before transplantation. IO was not the result of reduction in hepcidin secondary to hypererythropoietinemia. The elevated levels of serum hepcidin were possibly secondary to IO, mediated by mechanisms that are independent of the hepcidin-erythropoietin axis.

Acute pancreatitis associated with boceprevir: a case report

Approximately 170 million people are infected with hepatitis C, and the sustained virological response rate to treatment with pegylated interferon and ribavirin is 30-50%. In an attempt to improve the chances of cure, boceprevir is being added to therapy, but it is associated with an increased incidence of adverse events. We herein report a case of acute pancreatitis developed during treatment with pegylated interferon, ribavirin and boceprevir. Boceprevir was the most likely cause of drug-associated pancreatitis after the most common causes were ruled out, since this adverse event had not occurred when the patient had previously been exposed to pegylated interferon and ribavirin and there was no recurrence of the episode of pancreatitis when these two drugs were reintroduced. Acute pancreatitis is a rare adverse event associated with boceprevir therapy, but a potentially fatal event. Sequential determination of pancreatic enzymes should be considered during hepatitis C treatment with boceprevir.

Acute pancreatitis associated with boceprevir: a case report.

Approximately 170 million people are infected with hepatitis C, and the sustained virological response rate to treatment with pegylated interferon and ribavirin is 30-50%. In an attempt to improve the chances of cure, boceprevir is being added to therapy, but it is associated with an increased incidence of adverse events. We herein report a case of acute pancreatitis developed during treatment with pegylated interferon, ribavirin and boceprevir. Boceprevir was the most likely cause of drug-associated pancreatitis after the most common causes were ruled out, since this adverse event had not occurred when the patient had previously been exposed to pegylated interferon and ribavirin and there was no recurrence of the episode of pancreatitis when these two drugs were reintroduced. Acute pancreatitis is a rare adverse event associated with boceprevir therapy, but a potentially fatal event. Sequential determination of pancreatic enzymes should be considered during hepatitis C treatment with boceprevir.