title: Hepatitis C Treatment With Direct-Acting Antivirals in Kidney Transplant: Preliminary Results From a Multicenter Study.
abstract: Hepatitis C (HC) is a very relevant negative prognosis factor for graft and transplant recipient survival. New direct-acting antivirals (DAAs) allow us to solve this problem in an effective way. It is crucial to understand their real impact in our daily practice. We analyzed treatment results with DAA, free of interferon, in kidney transplant recipients (KTRs) from 15 Spanish hospitals (Grupo Español de Actualización en Trasplante), regarding effectiveness, tolerance, and impact on immunosuppression, renal function-proteinuria, and diabetes. One hundred nineteen KTRs were included (9 combined liver-kidney transplants). The main DAA used was sofobusvir (91%) combined with ledipasvir (55%), simeprevir (14%), or daclatasvir (13%); in 9 cases (7%), a paritaprevir-ritonavir-ombitasvir-dasabuvir combination (3D) was used; Ribavirin was used as a coadjuvant in 18%. Side effects were limited (23.5%) and without relevance in general, except in 7 patients for whom we needed to interrupt the treatment due to neurotoxicity (1) caused by drug interaction (3D and tacrolimus) or anemia (3) by Ribavirin or others. Ninety-four patients had completed the treatment when data were analyzed: virological response was seen in 97.8% % of cases. Liver function analysis improved: 84% normal versus 21% before starting the treatment (P < .001). Renal function and proteinuria did not change. Tacrolimus level at the end of DAA-treatment was significantly lower with respect to the beginning (5.8 ± 2.1 ng/mL vs. 7.4 ± 1.8 ng/mL, P = .03), despite a slight increase in the dose (2.6 mg/d vs. 2.3 mg/d, P = .17). DAA are highly effective in the treatment of hepatitis C in KTRs with good tolerance in general, making it possible to solve the problem and have a good chance to improve the prognosis in our transplantation patients. The use of these therapies in KTRs requires special control and coordination with digestive professionals, especially if 3D or Ribavirin is used.
authors.affiliation: Department of Nephrology, Hospital Virgen Del Rocio, Sevilla, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Gentil
authors.affiliation: Department of Nephrology, Hospital Virgen Del Rocio, Sevilla, Spain. Electronic address: cgonzalezcorvillo@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: González-Corvillo
authors.affiliation: Department of Nephrology, Hospital Vall D'Hebron, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Perelló
authors.affiliation: Department of Nephrology, Hospital De Cruces, Baracaldo, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Zarraga
authors.affiliation: Department of Nephrology, Hospital La Paz, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Jiménez-Martín
authors.affiliation: Department of Nephrology, Hospital Germans Trias I Pujol, Badalona, Spain.
authors.forename: L R
authors.initials: LR
authors.lastname: Lauzurica
authors.affiliation: Department of Nephrology, Complejo Hospitalario De A Coruña, A Coruña, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Department of Nephrology, Hospital San Juan, Alicante, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Franco
authors.affiliation: Department of Nephrology, Hospital Regional De Malaga, Malaga, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Hernández-Marrero
authors.affiliation: Department of Nephrology, Hospital Clinico De San Carlos, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Sánchez-Fructuoso
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage*; D001562:Benzimidazoles / Q000008:administration & dosage; D002219:Carbamates; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D005449:Fluorenes / Q000008:administration & dosage; D016174:Hepacivirus / Q000187:drug effects; D006526:Hepatitis C / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage; D007165:Immunosuppression Therapy / Q000379:methods; D016030:Kidney Transplantation; D047029:Lactams, Macrocyclic; D047028:Macrocyclic Compounds / Q000008:administration & dosage; D011183:Postoperative Complications / Q000188:drug therapy* / Q000821:virology; D011392:Proline / Q000031:analogs & derivatives; D011446:Prospective Studies; D011759:Pyrrolidines; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage; D000069616:Simeprevir / Q000008:administration & dosage; D000069474:Sofosbuvir / Q000008:administration & dosage*; D013030:Spain; D013449:Sulfonamides; D016896:Treatment Outcome; D014633:Valine / Q000031:analogs & derivatives
chemical_list: D000998:Antiviral Agents; D001562:Benzimidazoles; D002219:Carbamates; D003521:Cyclopropanes; D005449:Fluorenes; D007093:Imidazoles; D047029:Lactams, Macrocyclic; D047028:Macrocyclic Compounds; D011759:Pyrrolidines; D013449:Sulfonamides; C586541:ledipasvir; D012254:Ribavirin; D011392:Proline; D000069616:Simeprevir; D014633:Valine; C549273:daclatasvir; C585405:paritaprevir; D000069474:Sofosbuvir