Successful treatment of chronic hepatitis C virus genotype 1b infection of a patient with compensated cirrhosis after renal transplantation using daclatasvir-asunaprevir combination therapy: a case report and literature review

Abstract

Hepatitis C virus (HCV) infection a major disorder that is not only a liver-related disease but also a cardiovascular complication in renal transplant recipient. Interferon-based therapy is a contraindication after transplantation because interferon is possibly induced to graft rejection. Only limited anecdotal evidence exists on the antiviral efficacy and tolerability of HCV direct acting antivirals (DAAs) in patients with chronic kidney disease (CKD), including renal transplant recipients. Then, we report a successful treatment case of chronic hepatitis C virus genotype 1b infection in a patient with compensated cirrhosis after renal transplantation using daclatasvir-asunaprevir combination therapy and reviewed the literature. A 64-year-old female renal transplantation (RT) recipient complicated with compensated cirrhosis due to hepatitis C virus (HCV) genotype 1b infection was treated with interferon (INF)–ribavirin-free combinations of DAAs such as daclatasvir plus asunaprevir. She was medicated with daclatasvir 60 mg once a day and asunaprevir 100 mg twice a day for 24 weeks. Her initial HCV RNA was log10 6.2 IU/ml, and HCV RNA was not detected from 10 weeks. She achieved a sustained virological response at 24 weeks (SVR24). During this therapy, her serum creatinine and tacrolimus trough level were slightly elevated, but those abnormalities were returned to the basal level by decreasing the dose of extended-release tacrolimus. No other adverse event requiring discontinuation of the treatment occurred. Almost all DAA treatments of HCV infection in renal transplant recipients have been sofosbuvir-based antiviral treatment, but we considered that daclatasvir-asunaprevir combination therapy is suitable to renal-impaired recipient because sofosbuvir is contraindicated in patients whose estimated GFR is <30 ml/min/1.73 m2, and both of daclatasvir and asunaprevir are mainly primarily metabolized by the liver. We showed excellent effect daclatasvir-asunaprevir combination therapy to a renal transplant recipient with chronic HCV infection and reviewed the literature.