Hepatitis C Virus Infection in Kidney Transplant Recipients

Abstract

Grupo Español De Actualizacion En Trasplante. Background HCV is a relevant negative prognosis factor for graft and transplant recipient survival.New direct-acting antivirals(DAA)allow us to solve this problem in an effective way.It is crucial to know their real impact in our daily practice. Methods Observational,retrospective and prospective study.We analyze treatment results with DAA,in kidney transplant(KT)recipients from 15 hospitals,regarding effectiveness,tolerance and impact on immunosuppression and renal function-proteinuria in a short-medium term. Results Until November 2017,226 KT recipients were included (9combined liver- kidney transplants).69.7%male; average age 54.2±9yo;KT length 11.4±10years. More than 50%showed stage 3-4 chronic kidney disease. Immunosuppressive therapies: tacrolimus(70%) or cyclosporine (18%) with MMF(76%). Predominant genotype was 1b(68.1%), 1a(13.8%),3(7.8 %), 4(6%) and 2(4.3%);51% had grade 3-4 of fibrosis, 17% portal hypertension. The main DAA used was sofosbuvir(91%)combined with ledipasvir(55%), simeprevir(14%)or daclatasvir(13%);in 9 cases(7%)the combination of paritaprevir-ritonavir-ombitasvir-dasabuvir(3D)was employed;18% were treated with Ribavirin as coadjuvant. Side effects were limited,23.5 %,and without relevance, except for anemia caused by Ribavirin.2 patients interrupted the treatment, due to neurotoxicity caused by the interaction between 3D and tacrolimus and anemia caused by Ribavirin (both had virological response).All the patients that completed the treatment (213)are alive and show virological response in 98% of cases and with SVR-12.Liver function analysis improved: 74%normal vs 21% before the treatment (p<0.001). Renal function did not change significantly. Tacrolimus level at the end was lower with respect to the beginning (6.6 vs 7.3 ng/ml, p=0.03), in spite of a slight increase in the dose (3.5 vs 2.6 mg/day p=0.01). Conclusions DAA are highly effective in KT patients, with good tolerance,making it possible to solve the problem and having a good chance to improve the prognosis in our patients.The use of DAA in these patients requires special control and coordination with hepatologists, especially when 3D or Ribavirin is used.