Tenofovir disoproxil fumarate (TDF) demonstrated potent and sustainable antiviral efficacy and a good safety profile in patients with chronic hepatitis B (CHB) in controlled clinical trials. Real-world data are important to confirm effectiveness and safety data in patient populations encountered in routine clinical practice.

Antiviral therapy with interferon‐alpha (IFN‐alpha) and pegylated IFN‐alpha (PEG‐IFN‐alpha) for chronic hepatitis C (HCV)‐infected kidney recipients remains controversial. IFN‐alpha is not recommended in most cases because it induces severe acute graft rejection. However, IFN‐alpha, as PEG‐IFN‐alpha, is associated with a more pronounced immune response, and is well tolerated in HCV‐infected liver recipients without causing graft rejection. In combined liver–kidney transplant (LKT) recipients, IFN‐alpha has been occasionally used and appears to be well tolerated. All LKT recipients with a functioning kidney and liver having a HCV replication and who needed IFN‐alpha therapy have been included in the study. The occurrence of liver and/or renal acute rejection as well as the HCV replication has been collected. A total of 12 LKT patients treated with PEG‐IFN‐alpha plus ribavirin have been studied. No acute rejection was observed. Renal function remained stable during and after discontinuing treatment, without any graft dysfunction. Two patients had a partial viral response and four had a sustained viral response. All patients, whatever their viral response, had decreased liver‐enzyme levels. Response to PEG‐IFN‐alpha therapy was correlated with steroid dose and transaminase level when PEG‐IFN‐alpha was started. These data suggest that the combination therapy of PEG‐IFN‐alpha plus ribavirin did not have a higher risk of acute kidney‐graft rejection after liver–kidney transplantation.