Successful Management of Renal Transplant Recipients with Hepatitis C by Direct-Acting Antiviral Therapy: A Report on Three Cases

Abstract

We evaluated the efficacy of direct-acting antiviral (DAA) therapy in the management of renal transplant recipients with hepatitis C virus (HCV) infection. Methods: We treated two of our renal transplant recipients (Patients 1 and 2) who were HCV-RNA-(genotype 1b) positive with daclatasvir and asunaprevir. Another recipient (Patient 3), who was positive for HCV (genotype 2b), was treated with sofosbuvir and ribavirin. Patient 1 received DAA treatment following unsuccessful pegylated-interferon therapy. Prior to DAA therapy, his HCV-RNA level was 6.0 log IU/mL. After 8 weeks of treatment, DAA therapy was discontinued due to allograft dysfunction. In Patient 2, HCVRNA level before DAA therapy was 6.9 log IU/mL. In Patient 3, DAA therapy was initiated 4 months after renal transplantation, when the patient's HCV-RNA level was 7.4 log IU/mL. Results: In all cases, HCV-RNA was undetectable within 4 weeks of the initiation of DAA therapy and a sustained virological response was maintained. In Patient 1, transient deterioration of renal function gradually recovered. Patient 3 developed BK virus nephropathy (BKN) 5 weeks after completion of DAA therapy, although the relationship between DAA and BKN remains unclear. Conclusion: DAA therapy was successful in the therapeutic management of our three HCV-infected renal transplant patients. Although physicians should be aware of the possibility of complex drug interactions, DAA therapy under such conditions may provide promising short-term outcomes.