title: Elbasvir/Grazoprevir Use in Postliver Transplantation Patients on Hemodialysis.
abstract: Current national hepatitis C virus (HCV) guidelines do not recommend the use of elbasvir (EBR)/grazoprevir (GZR) in postliver transplantation (LT) patients due to drug-drug interactions with immunosuppression agents. However, recommendations do not address the treatment of HCV in renally impaired post-LT patients. Treatment regimens that are recommended for post-LT patients are not safe in patients with severe renal impairment and patients on dialysis. EBR/GZR is approved for use in patients with renal impairment and patients on dialysis, but not in the post-LT setting.
  
  
  
  Authors reviewed the electronic medical records of 3 treatment-naive HCV genotype 1a male post-LT patients on hemodialysis who were treated with EBR/GZR with or without ribavirin for 12 or 16 weeks.
  
  
  
  No patients had serious adverse drug events during treatment and no patients stopped treatment early or died. Providers monitored immunosuppression levels; both patients who were taking tacrolimus required immunosuppression dose adjustments during HCV treatment. No patients experienced organ rejection. All patients achieved sustained virologic response.
  
  
  
  Current HCV guidelines do not address the treatment options for post-LT patients with severe renal impairment or who are on dialysis, nor do published accounts of use of EBR/GZR in this patient population exist. Clinicians may benefit from exposure to real-world cases of HCV treatment in this historically difficult-to-cure patient population. Providers must address drug-drug interactions with EBR/GZR and monitor for changes in immunosuppression levels to ensure safety with its use in post-LT patients.
authors.affiliation: 1 Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, University of Illinois Hospital and Health Sciences System, Chicago, IL. 2 University of Illinois Hospital and Health Sciences System, University of Illinois at Chicago College of Medicine, Chicago, IL.
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Martin
authors.forename: Sean
authors.initials: S
authors.lastname: Koppe
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001572:Benzofurans / Q000009:adverse effects / Q000627:therapeutic use*; D004338:Drug Combinations; D004347:Drug Interactions; D016903:Drug Monitoring; D057286:Electronic Health Records; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011810:Quinoxalines / Q000009:adverse effects / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D001572:Benzofurans; D004338:Drug Combinations; D007093:Imidazoles; D007166:Immunosuppressive Agents; D011810:Quinoxalines; C000611265:elbasvir-grazoprevir drug combination