Abstract
The use of direct-acting antivirals (DAAs) for treatment of hepatitis C virus (HCV) infection has been shown to very effective. However, its efficacy and tolerability in kidney transplant recipients are unclear. A literature search was performed using MEDLINE, EMBASE, and Cochrane Databases from inception through January 2017. We included studies that reported crude numbers of kidney transplant patients who achieved sustained virological response (SVR) or developed adverse effects with DAA therapy. Pooled estimated rates of SVR at 12 weeks (SVR12) after DAA therapy and discontinuation rate of DAAs treatment with 95% confidence interval (CI) were assessed using a random-effect, generic inverse variance method. The study protocol is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017054575). Around, 24 studies with 892 kidney transplant recipients were included in the meta-analysis. The pooled estimated SVR12 rate with DAAs treatment for HCV among kidney transplant patients was 97% (95% CI: 95%-99%; I2 = 22%). The pooled estimated rate of discontinuation of DAAs treatment for HCV among kidney transplant patients was 2% (95% CI: 1%-3%; I2 = 0%). Reported treatment-related serious adverse events included bradycardia with syncope in the co-administration of sofosbuvir with amiodarone, pulmonary embolism, gastrointestinal bleeding, portal vein thrombosis, bacteremia, anemia particularly with regimens including ribavirin, and uncommonly increased serum creatinine. The findings of our study suggest excellent efficacy and tolerability profiles of DAA therapy for HCV infection in kidney transplant patient populations.
Highlights
Hepatitis C virus (HCV) infection universally affects greater than 200 million people worldwide [1]
Since direct-acting antivirals (DAAs) do not stimulate the host immune system, which is a main concern of IFN therapy, studies have implied that DAAs can be utilized for the eradication of HCV infection following renal transplantation [1,9,10,11]
The publication bias was insignificant. In this meta-analysis of 892 kidney transplant recipients, we showed an excellent efficacy of DAA therapy for treatment of HCV infection among kidney transplant recipients with overall estimated SVR at 12 weeks (SVR12) rate of HCV after DAA therapy in kidney transplant recipients of 97%
Summary
Hepatitis C virus (HCV) infection universally affects greater than 200 million people worldwide [1]. The prevalences of HCV infection in end-state kidney disease on hemodialysis (2.6%-22.9% in Western countries) and in kidney transplant recipients (1.8%-8% in developed countries) are higher than in the general population (~1% in the United States) [2,3,4,5]. Most kidney transplant patients have received HCV infection while on dialysis. Since DAAs do not stimulate the host immune system, which is a main concern of IFN therapy, studies have implied that DAAs can be utilized for the eradication of HCV infection following renal transplantation [1,9,10,11]. Its efficacy and tolerability in kidney transplant recipients are unclear. We conducted a meta-analysis to assess the efficacy (SVR 12) and safety of DAA therapy for HCV infection in kidney transplant recipients
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