Eradication of hepatitis C virus infection in kidney transplant recipients using direct‐acting antiviral therapy: Qatar experience

Abstract

Introduction Hepatitis C virus (HCV) infection has detrimental effects on patient and graft survival after kidney transplantation. In the pre‐direct‐acting antiviral (DAA) era, treatment of HCV infection was associated with low response rates, poor tolerance, and increased risk of allograft rejection. However, DAAs have revolutionized HCV treatment. The aims of this study were to determine the impact of DAA on the sustained virologic response (SVR), renal function, and calcineurin inhibitor (CNI) levels and assess the tolerability to treatment in kidney transplant recipients with HCV infection in Qatar. Methods This retrospective study included the medical records of all kidney transplant recipients with confirmed HCV infection before January 1, 2020. All data were obtained from the patients’ electronic medical records; these included patient demographics; virologic responses to treatment; serum creatinine levels during treatment; urine protein to creatinine ratios and CNI levels before, during, and after treatment; and side effects related to DAA therapy. Results A total of 27 kidney transplant recipients with HCV were identified, 23 of whom received DAA therapy. The length of treatment ranged from 12 to 24 weeks, and 52% of patients had HCV genotype 1 infection. The median log10 HCV RNA was 6.6 copies per milliliter. None of the patients had liver cirrhosis, and all of them achieved SVR. There was no statistically significant difference in the glomerular filtration rate before, during, and after treatment. Most patients had stable CNI trough levels during treatment and did not require dose adjustment. Conclusions HCV infection was successfully eradicated by DAA therapy in kidney transplant recipients, with a 100% SVR rate. Moreover, DAA therapy was well‐tolerated, and kidney function remained stable without an increased risk of rejection. These results are expected to drive the eradication of hepatitis C from the entire country.

Infection, Rejection, and the Connection

“…However, kidney transplant recipients treated with direct-acting antivirals (DAAs) do not have any increase in the risk of rejection. 95 In fact, DAA-treated recipients of HCV + kidneys have similar outcomes, with no increase in rejection, to recipients of HCV − kidneys. Thus, in the current era of DAA treatment, the impact of HCV on rejection is minimal.…”

“…• Chronic active infection associated with operational tolerance to liver transplant 93 • DAAs 94 • Viral clearance associated with donor reactivity, but no proven rejection, in liver transplant 94 • Pre-DAA therapies associated with rejection risk for kidney transplantation, but no elevated rejection risk for kidney recipients in DAA era 95 transcriptional analysis from human kidney transplant biopsies found an inflammatory macrophage gene signature that correlated with both higher degree of subclinical allograft injury and subsequent development of chronic rejection. 110 Thus, the proinflammatory states induced by CMV-infected monocytes and macrophages contribute to chronic rejection.…”