title: Hepatitis C Virus in Kidney Transplant Recipients: A Problem on the Path to Eradication.
abstract: BACKGROUND
  Hepatitis C virus (HCV) still has significant prevalence in kidney transplant (KT) recipients and is related to poor recipient and graft survival. New direct-acting antivirals (DAA) are leading to a radical change in the problem.
  
  
  METHODS
  We studied HCV prevalence at the time of transplantation and in follow-up patients, the way cases are handled, and the results of DAA.
  
  
  RESULTS
  A total of 2,001 KT had been performed in our center since 1978. Pre- or post-transplantation HCV serology was present in 1,880 cases and was positive in 13.4%. A total of 1,195 transplant recipients were still being monitored by us, with only 60 (5%) HCV+ and 45 (3.6%) RNA+ cases. Of these 45 HCV+/RNA+, 25 had been or were being treated, 7 were about to begin treatment, 1 was awaiting new DAA treatment owing to low glomerular filtration rate (GFR), 3 were being evaluated, 2 had been excluded owing to high comorbidity, 2 refused to be treated, 2 needed to return to hemodialysis, and 1 was lost to follow-up. Except 1 case where Viekira Pak was used because of low GFR, all cases included sofosbuvir as the main drug associated with either ledipasvir (70%) or daclatasvir (25%). Ribavirin was added as coadjuvant in 35% of cases. Twenty-one patients had completed treatment (84%). Two patients had to interrupt DAA therapy (8%), one because of hepatotoxicity and the other as a result of a liver transplantation. In every case, the graft maintained function and negativization of viral replication occurred.
  
  
  CONCLUSIONS
  Side effects have been low, anemia related to ribavirin being the main one. Just one case needed to be interrupted at the 7th week of DAA therapy due to hepatotoxicity. It has frequently been necessary to adjust immunosuppression treatment with the use of higher doses of tacrolimus.
authors.affiliation: Nephrology, Hospital Virgen del Rocio, Sevilla, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Suarez Benjumea
authors.affiliation: Nephrology, Hospital Virgen del Rocio, Sevilla, Spain. Electronic address: cgonzalezcorvillo@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Gonzalez-Corvillo
authors.affiliation: Nephrology, Hospital Virgen del Rocio, Sevilla, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Sousa
authors.affiliation: Nephrology, Hospital Virgen del Rocio, Sevilla, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Bernal Blanco
authors.affiliation: Nephrology, Hospital Virgen del Rocio, Sevilla, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Suñer Poblet
authors.affiliation: Nephrology, Hospital Virgen del Rocio, Sevilla, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Perez Valdivia
authors.affiliation: Nephrology, Hospital Virgen del Rocio, Sevilla, Spain.
authors.forename: F M
authors.initials: FM
authors.lastname: Gonzalez Roncero
authors.affiliation: Nephrology, Hospital Virgen del Rocio, Sevilla, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Acevedo
authors.affiliation: Nephrology, Hospital Virgen del Rocio, Sevilla, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Gentil Govantez
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival; D016174:Hepacivirus; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015994:Incidence; D007668:Kidney / Q000821:virology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000821:virology; D012254:Ribavirin / Q000627:therapeutic use; D000069474:Sofosbuvir / Q000627:therapeutic use*; D016559:Tacrolimus / Q000008:administration & dosage
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D012254:Ribavirin; D000069474:Sofosbuvir; D016559:Tacrolimus