Brief Communication
Successful Treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents

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The direct-acting antivirals (DAAs) constitute an emerging group of small molecule inhibitors that effectively treat hepatitis C virus (HCV) infection, a common comorbidity in end-stage renal disease patients. To date, there are no data to guide use of these agents in kidney transplant patients. The authors collected data from 20 consecutive kidney recipients treated with interferon-free treatment regimens for HCV at their center: 88% were infected with genotype 1; 50% had biopsy-proved advanced hepatic fibrosis on their most recent liver biopsy preceding treatment (Metavir stage 3 fibrosis [F3] or F4); and 60% had failed treatment pretransplantation with interferon-based therapy. DAA treatment was initiated a median of 888 days after renal transplantation. All patients cleared the virus while on therapy, and 100% have achieved a sustained virologic response at 12 weeks after completion of DAA therapy. The most commonly used regimen was sofosbuvir 400 mg daily in combination with simeprevir 150 mg daily. However, four different treatment approaches were used, with comparable results. The DAAs were well tolerated, and less than half of patients required calcineurin inhibitor dose adjustment during treatment. Eradication of HCV infection with DAAs is feasible after kidney transplantation with few treatment-related side effects.

Abbreviations

AASLD
American Association for the Study of Liver Diseases
CNI
calcineurin inhibitor
CyA
cyclosporin A
DAA
direct-acting antiviral
DCV
daclatasvir
ESRD
end-stage renal disease
F
fibrosis stage
GFR
glomerular filtration rate
HIV
human immunodeficiency virus
IDSA
Infectious Diseases Society of America
IQR
interquartile range
LDV
ledipasvir
MMF
mycophenolate mofetil
NODAT
new-onset diabetes after transplantation
RBV
ribavirin
SIM
simeprevir
SOF
sofosbuvir
SVR
sustained viral response

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