Abstract
The prevalence of Hepatitis C Virus (HCV) infection is significantly higher in patients with end-stage renal disease compared to the general population and poses important clinical challenges in patients who undergo kidney transplantation. Historically, interferon-based treatment options have been limited by low rates of efficacy and significant side effects, including risk of precipitating rejection. Limited data exist on the use of all-oral, interferon-free direct-acting antiviral (DAA) therapies in kidney transplant recipients. In this study, we performed a retrospective chart review with prospective clinical follow-up of post-kidney transplant patients treated with DAA therapies at three major hospitals in Boston, MA. A total of 24 kidney recipients with HCV infection received all-oral DAA therapy post-transplant. Patients were predominantly male (79%) with a median age of 60 years (range 34–70 years), median creatinine of 1.2 mg/dL (0.66–1.76), and 42% had advanced fibrosis or cirrhosis. The majority had HCV genotype 1a infection (58%). All patients received full-dose sofosbuvir; it was paired with simeprevir (9 patients without and 3 patients with ribavirin), ledipasvir (7 patients without and 1 patient with ribavirin) or ribavirin alone (4 patients). The overall sustained virologic response (SVR12) was 91% (21 out of 23 patients). One patient achieved SVR4 but demised prior to SVR12 check point due to treatment unrelated cause. Two treatment failures were successfully retreated with alternative DAA regimens and achieved SVR. Both initials failures occurred in patients with advanced fibrosis or cirrhosis, with genotype 1a infection, and prior HCV treatment failure. Adverse events were reported in 11 patients (46%) and were managed clinically without discontinuation of therapy. Calcineurin inhibitor trough levels did not significantly change during therapy. In this multi-center series of patients, all-oral DAA therapy appears to be safe and effective in post-kidney transplant patients with chronic HCV infection.
Highlights
Hepatitis C virus (HCV) infection affects more than 200 million people worldwide and is highly prevalent in patients with end-stage renal disease, leading to significant challenges in kidney transplant recipients
While our study demonstrated efficacy, the length of follow-up was limited and future studies will be needed to determine if treatment of HCV with direct-acting antiviral (DAA) in the post-transplant period leads to improved long-term graft survival and overall mortality
Our study demonstrated success in using an all-oral interferon-free antiviral regimen in a heterogeneous and complex post-kidney transplant population with chronic hepatitis C infection with the common genotype 1 and 2
Summary
Hepatitis C virus (HCV) infection affects more than 200 million people worldwide and is highly prevalent in patients with end-stage renal disease, leading to significant challenges in kidney transplant recipients. Approximately 1.8% to 8% of kidney transplant recipients are infected with HCV.[1,2]. Despite these risks, it is still recommended that HCV-infected patients undergo kidney transplantation, as their mortality has been clearly demonstrated to improve after transplant compared to remaining on hemodialysis.[12,13]
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