Abstract
Hepatitis C virus (HCV) causes increased mortality and morbidity in kidney transplant patients. Interferon-based therapies are poorly tolerated and involve the risk of rejection. The new direct-acting antiviral drugs (DAAs) have revolutionized the treatment of HCV infection in transplant patients. This observational study evaluates changes in immunosuppressive therapy during treatment with DAA in renal transplant recipients.In our transplant center, we selected seven HCV-positive patients at the time of transplantation , four men and three women, with an average age of 61 ± 7 years, in therapy with DAA. The dose and the blood levels of the immunosuppressive drugs were evaluated at the beginning and end of antiviral therapy, together with creatinine and proteinuria.Viremia was negativized in all patients within the initial 8 weeks of therapy. Currently, the number of patients is too limited to perform a sta-tistical analysis and obtain significant results. In one patient, the dose of Cyclosporine was lowered to 10 mg, while for the remaining patients it was not necessary to change the dose of immunosuppressive drugs.DAAs give encouraging results in the eradication of HCV in renal transplant recipients, although they are associated with potential adverse drug interactions. The preliminary data of our study suggest that it is not necessary to change the dose of immunosuppressive drugs during therapy and that creatinine and proteinuria remain stationary. We will achieve more significant results in the future, adding more patients to our study. However, further randomized trials are necessary to confirm the safety of DAAs.
Highlights
Before the introduction of new direct-acting antiviral drugs (DAAs), anti-hepatitis C virus (HCV) therapy was based on Interferon and Ribavirin, but these drugs were poorly used in kidney transplantation because of an increased risk of rejection and direct nephrotoxicity, respectively
We evaluated serum creatinine, estimated glomerular filtration range, blood urea nitrogen (BUN), 24-h proteinuria, viral load by means of HCV RNA, Alaline Amino Transferase (ALT), Aspartate Amino Transaminase (AST), total bilirubin, alkaline phosphatasis, gammaglutamiltransferasis (GGT), cyclosporine (Cya) or tacrolimus (Fk) trough levels, and the dose of Cya and Fk
Blood level of Cya or Fk remained substantially stable in all the patients except in one patient for whom it was necessary to reduce the dose of Cya of 10 mg
Summary
Before the introduction of new direct-acting antiviral drugs (DAAs), anti-hepatitis C virus (HCV) therapy was based on Interferon and Ribavirin, but these drugs were poorly used in kidney transplantation because of an increased risk of rejection and direct nephrotoxicity, respectively.The use of DAAs has revolutionized the treatment of HCV infection, leading to a very effective clearance of viral load and expanding the population of potentially treatable patients.There have been debates regarding the use of DAAs in kidney transplantation because of potential interactions with the immunosuppressive drugs.Journal of Renal and Hepatic Disorders 2020; 4(1): 31–34Evidence from literature has demonstrated that an adjustment in immunosuppressive medications was necessary in 18% of kidney transplant patients treated with DAAs (1).In this study, we evaluated retrospectively the safety and efficacy of DAAs in kidney transplant patients. Before the introduction of new direct-acting antiviral drugs (DAAs), anti-hepatitis C virus (HCV) therapy was based on Interferon and Ribavirin, but these drugs were poorly used in kidney transplantation because of an increased risk of rejection and direct nephrotoxicity, respectively. The use of DAAs has revolutionized the treatment of HCV infection, leading to a very effective clearance of viral load and expanding the population of potentially treatable patients. There have been debates regarding the use of DAAs in kidney transplantation because of potential interactions with the immunosuppressive drugs. Journal of Renal and Hepatic Disorders 2020; 4(1): 31–34. Evidence from literature has demonstrated that an adjustment in immunosuppressive medications was necessary in 18% of kidney transplant patients treated with DAAs (1). We evaluated retrospectively the safety and efficacy of DAAs in kidney transplant patients
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