title: Experience with direct acting anti-viral agents for treating hepatitis C virus infection in renal transplant recipients.
abstract: In recent past, direct-acting anti-viral drugs (DAAs) have become the standard of care for the treatment of hepatitis C virus (HCV) infection. However, the experience with the use of these drugs in Indian renal transplant recipients is limited. We retrospectively reviewed our experience with DAA-based treatment for HCV infection in such patients. Between April 2015 and December 2016, six adults (median age 41 [range 34-52] years, male 5; GT1 2, GT3 3, and GT4 1; including three with prior failed interferon-based treatment) had received genotype-guided, DAA-based anti-HCV treatment 1 to 158 (median 15) months after renal transplantation. Of them, four completed the planned 24-week treatment without any significant adverse event. One of them had increase in serum creatinine after 16 weeks of treatment with sofosbuvir and daclatasvir, with acute interstitial nephritis on kidney biopsy; his renal function improved on stopping the drugs. The other patient had preexisting mild renal dysfunction, which worsened after 8 weeks of sofosbuvir-ledipasvir treatment; this did not reverse on stopping treatment. All the six patients achieved undetectable HCV RNA after 4 weeks of treatment and also achieved sustained virologic response, i.e. lack of detectable HCV RNA in serum 12 weeks after stopping treatment. Overall, DAA-based treatment was effective in treating HCV infection in our renal transplant recipients; however, caution and monitoring of renal function during such treatment is advisable in patients who have additional factors that predispose to renal injury.
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Goel
authors.affiliation: Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
authors.forename: Dharmendra Singh
authors.initials: DS
authors.lastname: Bhadauria
authors.affiliation: Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
authors.forename: Anupma
authors.initials: A
authors.lastname: Kaul
authors.affiliation: Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
authors.forename: Narayan
authors.initials: N
authors.lastname: Prasad
authors.affiliation: Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
authors.forename: Raj Kumar
authors.initials: RK
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
authors.forename: Praveer
authors.initials: P
authors.lastname: Rai
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India. aggarwal.ra@gmail.com.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Aggarwal
mesh_terms: D000208:Acute Disease; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D002219:Carbamates; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage* / Q000009:adverse effects*; D007194:India; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control; D011759:Pyrrolidines; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D000069474:Sofosbuvir / Q000008:administration & dosage* / Q000009:adverse effects*; D013997:Time Factors; D014633:Valine / Q000031:analogs & derivatives
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D002219:Carbamates; D007093:Imidazoles; D011759:Pyrrolidines; D012367:RNA, Viral; D003404:Creatinine; D014633:Valine; C549273:daclatasvir; D000069474:Sofosbuvir
keywords: Chronic kidney disease; Hepatitis C virus; Maintenance dialysis; Renal transplantation