Efficacy and safety of new direct-acting antivirals in kidney transplant recipients with chronic hepatitis C: a single-center study

Abstract

Background The recent interferon-free direct-acting antiviral (DAA) regimens have very good safety and efficacy profiles and are highly recommended for kidney transplant (KT) recipients with chronic hepatitis C (CHC). Methods All KT recipients with CHC followed at our hospital and who received therapy with the current DAAs were included. At the baseline visit, demographic, clinical and laboratory variables before and after KT, as well as at the commencement of DAAs, at the end of antiviral therapy and the end of follow up, were recorded, including assessment of glomerular filtration rate (eGFR). The changes in eGFR (DGFR) between baseline and end of therapy (1 st period), and between end of therapy and end of follow up (2 nd period), were evaluated. Results Twelve KT recipients were retrospectively evaluated: 2 had received antiviral therapy in the past; 4 (33.3%) patients had genotype 1 and 3 (25%) genotype 4 CHC. The median stiffness was 11.9 kPa (range 5-16.8), while 5 patients, none with decompensated cirrhosis, had stiffness >12.5 kPa. Eight patients received a sofosbuvir-containing antiviral regimen (Group 1) and 4 patients received an antiviral regimen without sofosbuvir (Group 2). Eleven (91.7%) patients achieved a sustained virological response (SVR). One patient discontinued DAAs early after treatment and did not achieve SVR. Otherwise, DAAs were well tolerated and no rejection episode was recorded. The DGFRs in the 1 st period and 2 nd period did not differ significantly between Group 1 and Group 2 patients. Conclusion In this real-world study of KT recipients with CHC, the high efficacy and clinically acceptable tolerability of DAAs were confirmed.

Revolution in the diagnosis and management of hepatitis C virus infection in current era

“…Early in DAAs era, SOF was not recommended in patients with eGFR < 30 mL/min due to possible accumulation of SOF and its metabolites causing renal dysfunction[ 71 ]. However, various studies have reported favorable response of SOF with RBV in RTRs[ 149 , 150 ]. We have observed 89.2% end-of-treatment response (ETR) and 100% SVR12 in our renal transplant population treated exclusively with SOF and RBV combination.…”

The Role of IL-35 in the Pathophysiological Processes of Liver Disease

“…Moreover, those patients recovering from treatment still remained the risk of reinfection. Despite effective direct-acting antiviral drugs (DAA) were introduced, there were still strong recommendations for preventive HCV vaccination ( Darema et al, 2020 ; Martinello et al, 2020 ). Among the 73 HCV patients, the expression level of IL-35 in serum was observed to elevate in HCV patients.…”