Hepatitis C Treatment With Direct-Acting Antivirals in Kidney Transplant: Preliminary Results From a Multicenter Study

Gentil, M.A.; González-Corvillo, C.; Perelló, Manel; Zárraga, Sofía; Jiménez-Martín, Carlos; Lauzurica, L.R.; Alonso, Ángel; Franco, Antônio; Marrero, Domingo Hernández; Sánchez-Fructuoso, A.

doi:10.1016/j.transproceed.2016.07.034

Cited by 23 publications

(12 citation statements)

References 7 publications

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“…This clinical course was associated with worse outcomes for patients with ATN versus other three groups (risk, injury and HRS) for probability of CKD at 1 year (>50% vs. 10–20%, P < 0.001) and lower 5‐year survival for patients with ATN (<45% vs. 75–80%, P < 0.001) . While the outcomes of liver and SLK transplants have traditionally been poorer among patients transplanted for hepatitis C virus (HCV)‐related cirrhosis compared to other indications of liver disease , the emergence of direct antiviral agents for the treatment of chronic HCV infection has revolutionized and changed this paradigm .…”

Section: Outcomes Of Slk Transplantationmentioning

confidence: 99%

Simultaneous liver kidney transplantation

et al. 2019

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Summary Kidney injury is frequently seen in patients with end‐stage liver disease from cirrhosis and liver failure. Among selected patients, simultaneous liver kidney (SLK) transplantation provides improved post‐transplant graft and patient outcomes compared to liver transplantation (LT) alone. We conducted the review of the existing literature on SLK transplant criteria and outcomes. Since the introduction of the model for end‐stage disease (MELD) score in 2002, there has been an increased use of SLK transplantation. The criteria for SLK allocation are relatively homogeneous among patients with end‐stage renal disease with cirrhosis and among patients with cirrhosis and chronic kidney disease. However, these are quite heterogeneous among patients with cirrhosis and acute kidney injury (AKI), mainly because of inability to accurately differentiate cause of AKI, especially hepatorenal syndrome versus intrarenal aetiology. Clearly, there is an unmet need of urine biomarkers of tubular injury and/or clinical models to accurately stratify AKI aetiology and to predict renal recovery after LT as basis to best utilize the scarce donor kidney pool. In this regard, it remains to be seen whether recently implemented policies by the organ procurement transplant network can fulfil the goal of saving donor kidneys and optimal allocation of SLK.

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Section: Outcomes Of Slk Transplantationmentioning

confidence: 99%

Simultaneous liver kidney transplantation

et al. 2019

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“…Ritonavir ile eş zamanlı kullanımda takrolimus serum düzeyinin 57 kata kadar ve CsA serum düzeyinin 6 kat kadar yükselebildiği belirtilmiştir. 3D rejimi tercih etmek zorunda kalınacaksa, antiviral tedavi başlangıcında takrolimus dozunu 0.5mg/hafta olacak şekilde, CsA dozunu ise %80 oranında azaltarak kalsinorin inhibitör düzeylerinin her hafta izlenmesi faydalı olur (4,9,10 …”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisi Turkish Neunclassified

“…Bu denli ağır olgularda beyin MR görüntüleme yapılmalı ve destek tedavisi ile birlikte transplante böbrekten biyopsi örneği alınmalıdır. ABH nedeniyle benzer bir olgunun hemodiyaliz gereksinimi de ortaya çıkabilir ancak hemodiyaliz tedavisi plazmadaki kalsinorin inhibitörlerini uzaklaştıramamaktadır (9,11,16). Takip ettiğimiz olguda hızlı klinik düzelme olduğu için bu uygulamalara ihtiyaç duyulmadı.…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisi Turkish Neunclassified

“…HCV pozitif olan böbrek alıcılarında greft ömrü, olmayanlara göre daha kı-sadır. Greft kaybı da büyük oranda HCV ilişkili membranoproliferatif glomerülonefrite bağlı olmaktadır (3,9). Öyleyse HCV pozitif böbrek nakli alıcıları yakından takip edilmeli ve RNA pozitif olduğunda yeni antivirallerle tedavi edilerek sürdürülebi-lir viral yanıt sağlanmalıdır.…”

Section: Sonuçunclassified

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Böbrek Nakli Sonrası Hepatit C Virüs Enfeksiyonu Tedavisi ve İlaç Etkileşimleri; Olgu ve Literatürün Gözden Geçirilmesi

Erken¹,

Altunören²,

Tütüncü³

et al. 2018

Turk Neph Dial Transpl

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ÖZYeni direkt etkili antiviraller ile hepatit-C virüs (HCV) enfeksiyonunun etkin tedavisi mümkün olabilmektedir. Böbrek nakli sonrası ortaya çıkan veya nüks eden HCV enfeksiyonu tedavisi özenli bir yaklaşım gerektirir. Uygun tedavi seçimi yanında ilaç etkileşimleri de iyi bilinmelidir. Bu olgu sunumu ve literatür derlemesinde, HCV için tedavi başlandığı dönemde kalsinorin inhibitörü toksisitesi gelişen bir olguyu tanımlarken, böbrek nakli sonrası antiviral tedavide ilaç etkileşimlerine dikkat çekmeyi amaçladık. Kırk-sekiz yaşında böbrek nakilli erkek olgu genotip-1b nüks HCV enfeksiyonu için tedavi başlanması sonrasında ritonavir ile ilaç etkileşimine bağlı akut, şiddetli takrolimus toksisitesi nedeniyle takip edildi. Antiviral tedavi ve takrolimus kullanımı durduruldu. Klinik düzelme olduktan sonra hasta düşük doz siklosporin-A (CsA) eşliğinde antiviral tedavi alabildi ve sürdürülebilir viral yanıt elde edildi. Böbrek nakli alıcılarında uygun antiviral kombinasyonu seçerken HCV genotipi ve klinik özelliklerin yanı sıra immunosupressif ilaçlarla olası etkileşimlerin de dikkate alınması gerekeceği için, bu olgular hepatolog ve transplant nefroloğu tarafından yakın izlenmelidir. ANAHTAR SÖZCÜKLER: Böbrek nakli, Hepatit C virüs, İlaç etkileşimleri, Takrolimus, Ritonavir ABSTRACTNew direct acting antiviral agents are quite effective in treating hepatitis-C virus infection (HCV). Treating HCV that occurs or relapses after kidney transplantation necessitates a heedful approach for selecting the proper antiviral alternatives with respect to possible drug interactions. Here we want to lay emphasis on drug interactions in kidney transplant recipients along with a case that developed calcineurin inhibitor toxicity after initiation of anti-HCV treatment. A 48-year-old male was admitted after acute severe toxicity with tacrolimus due to a drug interaction with an antiviral regimen including ritonavir for relapsing genotype-1b HCV infection. Cessation of tacrolimus and antiviral therapy provided recovery. Sustained viral response was achieved with the same antiviral regimen with conversion to very low dose cyclosporine-A (CsA). Selection of a proper anti-HCV treatment combination for kidney transplant recipients requires consideration of the viral genotype, clinical features and possible drug interactions with immunosuppressives. These patients must therefore be followed by a hepatologist as well as a nephrologist.

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“…The treatment was discontinued in 7 patients because of the development of neurotoxicity caused by drug interaction (3D therapy and tacrolimus) or ribavirininduced anemia. 52 Another Spanish study reported the results of DAA treatment in 103 HCV-positive kidney transplant recipients (26 with combined liver-kidney transplants and 4 with combined pancreatic-kidney transplants). Hepatitis C virus genotype 1 was the cause of infection in 83% of patients.…”

Section: Treatment Of Hepatitis C Virus Infection In Renal Transplantmentioning

confidence: 99%

Untitled

2017

Exp Clin Transplant

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Hepatitis C virus infection is highly prevalent among kidney transplant recipients, occurring consequently to their previous treatment with hemodialysis. Hepatitis C virus infection has been associated with lower graft and patient survival compared with that shown in patients without infection. The lower survival has been associated with the posttransplant progression of liver disease and increased risk for development of extrahepatic complications. The choice of immunosuppressive drugs could significantly affect the course of the infection with an accelerated viral replication after kidney transplant. Eradicating hepatitis C virus infection with antiviral treatment is imperative to increasing graft and patient survival after transplant. Antiviral treatment options include standard interferon-based therapy and new directacting antiviral agents. Interferon-based treatment is rarely used in kidney transplant recipients because it has been associated with high risk of interferoninduced acute graft rejection. Several novel studies have shown that the new direct-acting antiviral agents are highly efficacious for treatment of hepatitis C infection in kidney transplant patients. Key words: Antiviral agents, Immunosuppression, Renal transplantation IntroductionHepatitis C virus (HCV) infection is relatively common among patients on hemodialysis and in kidney transplant recipients. 1 In developed countries, approximately 1.8% to 8% of the kidney transplant recipients are infected with HCV. 2,3 Hepatitis C virus infection has negative effects on both patient and graft survival. 2,4,5 A meta-analysis demonstrated that the presence of HCV antibodies was an independent and significant risk factor for death (risk ratio = 1.79; 95% confidence interval [CI], 1.57-2.03; P = .042) and graft failure (risk ratio = 1.56; 95% CI, 1.35-1.80; P = .019) after kidney transplant. 6 The lower survival was related to the posttransplant progression of liver disease induced by the use of immunosuppressive regimens 7,8 and increased risk for development of extrahepatic complications of HCV infection, including posttransplant de novo or recurrent glomerular disease and new-onset diabetes mellitus. 9,10 However, despite these risks, renal transplant is still recommended in HCV-positive patients, as survival is significantly better in those who undergo transplant versus infected patients who remain on hemodialysis. 11,12 Immunosuppressive drugs and hepatitis C virus infection The natural course of HCV infection in kidney transplant patients is more complex than in nontransplant patients. The use of immunosuppressive drugs could promote viral replication in hepatocytes and enhance the progression of liver disease or lead to reactivation of the HCV infection, which presents as acute hepatitis. [13][14][15] Controversy remains regarding what is the optimal immunosuppressive regimen for kidney transplant recipients with HCV infection. The use of induction therapy is not contraindicated in HCV-positive kidney transplant recipients. 16 Corticos...

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Hepatitis C Treatment With Direct-Acting Antivirals in Kidney Transplant: Preliminary Results From a Multicenter Study

Cited by 23 publications

References 7 publications

Simultaneous liver kidney transplantation

Simultaneous liver kidney transplantation

Böbrek Nakli Sonrası Hepatit C Virüs Enfeksiyonu Tedavisi ve İlaç Etkileşimleri; Olgu ve Literatürün Gözden Geçirilmesi

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