title: Safety and Efficacy of Treatment of Hepatitis C in Kidney Transplant Recipients With Directly Acting Antiviral Agents.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: 1 Division of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 2 Division of Medicine, Columbia University Medical Center, New York, NY.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lubetzky
authors.forename: Soohwan
authors.initials: S
authors.lastname: Chun
authors.forename: Andrew
authors.initials: A
authors.lastname: Joelson
authors.forename: Maria
authors.initials: M
authors.lastname: Coco
authors.forename: Layla
authors.initials: L
authors.lastname: Kamal
authors.forename: Maria
authors.initials: M
authors.lastname: Ajaimy
authors.forename: Paul
authors.initials: P
authors.lastname: Gaglio
authors.forename: Enver
authors.initials: E
authors.lastname: Akalin
authors.forename: Graciella
authors.initials: G
authors.lastname: De Boccardo
mesh_terms: D000368:Aged; D064591:Allografts; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000139:chemically induced; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents