Safety and Efficacy of Treatment of Hepatitis C in Kidney Transplant Recipients With Directly Acting Antiviral Agents
| Autor: | Maria Coco, Graciella de Boccardo, Andrew Joelson, Soohwan Chun, Maria Ajaimy, Layla Kamal, Enver Akalin, Paul J. Gaglio, Michelle Lubetzky |
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| Rok vydání: | 2016 |
| Předmět: |
Ledipasvir
Male medicine.medical_specialty Time Factors Sofosbuvir 030232 urology & nephrology Renal function Kidney Gastroenterology Antiviral Agents 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Risk Factors Internal medicine medicine Humans Kidney surgery Kidney transplantation Aged Retrospective Studies Transplantation Proteinuria business.industry Graft Survival Hepatitis C Middle Aged Viral Load medicine.disease Allografts Kidney Transplantation Treatment Outcome chemistry Kidney Failure Chronic 030211 gastroenterology & hepatology Female medicine.symptom business Viral load medicine.drug Glomerular Filtration Rate |
| Zdroj: | Transplantation. 101(7) |
| ISSN: | 1534-6080 |
| Popis: | BACKGROUND With the development of all oral, interferon-free directly acting antiviral (DAA) medications, treatment of hepatitis C virus (HCV) infection in renal transplant recipients is possible, but limited data exists on its safety and efficacy. METHODS We performed a retrospective cohort analysis of patients transplanted at our center with HCV who have been started on DAAs. Primary endpoints included sustained virologic response as defined as negative viral load at 12 weeks postcompletion of therapy and allograft function. RESULTS A total of 31 patients met inclusion criteria. The most commonly used regimen was sofosbuvir and ledipasvir (n = 21). Of the treated patients, 100% had undetectable viral load at the completion of therapy. Of the 31 patients treated, 30 (97%) achieved sustained virologic response. Both graft and patient survivals at most recent follow-up was 100%. There was no significant change in glomerular filtration rate (GFR) before or after therapy (64.2 ± 16.5 mL/min per body surface area before vs. 58.9 ± 17.5 mL/min per body surface area after therapy; P = 0.22); however, 3 patients now have GFR less than 20. A total of 6 (19.3%) of 31 patients had worsening proteinuria during or shortly after therapy. Patients with more than 500 mg/g of proteinuria at the start of treatment were significantly more likely to develop worsening proteinuria than those with less than 500 mg/g of proteinuria at the start of therapy (P < 0.001). Retrospective review of 20 untreated HCV patients did not demonstrate worsening allograft function and proteinuria during a median follow-up time of 1386 days (range, 332-6254). CONCLUSIONS Our preliminary data demonstrate that DAAs can be used safely and effectively in patients after kidney transplantation. Patients with proteinuria or lower GFR should be monitored more closely. |
| Databáze: | OpenAIRE |
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