Background. In hepatitis C virus (HCV) positive kidney transplant (KT) patients, the use of alpha-interferon (αIFN) is contraindicated due to the risk of acute rejection (AR). Conversely, if these HCV(+) KT patients lose their allograft, re-transplantation might be contemplated provided αIFN therapy has been attempted. Methods. Between 01/01/1989 and 31/12/1994, 261 kidney transplantations were performed; of these 174 were HCV(-) (group I) and 87 were HCV(+) (group II). Results. At last follow-up (2006), in group I, the number of patients with a functioning graft, the number of patients who died with a functioning graft, and the number of patients who lost their graft before or after month (M) 12 were 92 (52.8%), 14 (8%), 20 (11.5%) and 48 (27.7%), respectively. In group II, the corresponding figures were 22 (25.3%; P P Conclusions. We conclude that even αIFN-treated KT patients with a failed allograft can experience acute allograft rejection that requires transplantectomy during therapy. [ABSTRACT FROM AUTHOR]