Interventions for dialysis patients with hepatitis C virus (HCV) infection

Attur, Ravindra Prabhu; Goyal, Naresh Kumar; Nair, N. Sreekumaran; Pai, Girish K; Wadhwa, Tarun

doi:10.1002/14651858.cd007003

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…Until now, interferon‐based regimens administered before transplantation have been considered the mainstay of HCV treatment in kidney transplant recipients, although a meta‐analysis of randomized controlled trials with interferon indicates that this approach has been limited by relatively low efficacy and poor tolerability. Interferon‐based regimens have been least effective in treating genotype 1 infection, the most prevalent genotype in the US end‐stage renal disease (ESRD) population .…”

Section: Introductionmentioning

confidence: 99%

Successful Treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents

Sawinski

Kaur

Ajeti

et al. 2016

American Journal of Transplantation

208

194

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The direct-acting antivirals (DAAs) constitute an emerging group of small molecule inhibitors that effectively treat hepatitis C virus (HCV) infection, a common comorbidity in end-stage renal disease patients. To date, there are no data to guide use of these agents in kidney transplant patients. The authors collected data from 20 consecutive kidney recipients treated with interferonfree treatment regimens for HCV at their center: 88% were infected with genotype 1; 50% had biopsy-proved advanced hepatic fibrosis on their most recent liver biopsy preceding treatment (Metavir stage 3 fibrosis [F3] or F4); and 60% had failed treatment pretransplantation with interferon-based therapy. DAA treatment was initiated a median of 888 days after renal transplantation. All patients cleared the virus while on therapy, and 100% have achieved a sustained virologic response at 12 weeks after completion of DAA therapy. The most commonly used regimen was sofosbuvir 400 mg daily in combination with simeprevir 150 mg daily. However, four different treatment approaches were used, with comparable results. The DAAs were well tolerated, and less than half of patients required calcineurin inhibitor dose adjustment during treatment. Eradication of HCV infection with DAAs is feasible after kidney transplantation with few treatment-related side effects.

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Section: Introductionmentioning

confidence: 99%

Successful Treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents

Sawinski

Kaur

Ajeti

et al. 2016

American Journal of Transplantation

208

194

View full text Add to dashboard Cite

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“…In renal transplant patients, the presence of HCV can result in numerous complications such as reduced survival of patients and renal allografts, increased liver fibrosis and infection rates, glomerulonephritis, new-onset diabetes mellitus and cardiovascular disease [1]. Although IFN-based regimens have been considered as pivotal components of HCV treatment, some reports argue that the effectiveness of IFN is limited by its relatively low efficacy and poor tolerability in patients with ESRD [5]. Furthermore, IFN-based anti-HCV therapy is somewhat contraindicated in renal transplant cases because of an increased risk of acute rejection because of the immunostimulatory properties of IFN [6].…”

Section: Resultsmentioning

confidence: 99%

Successful Management of Renal Transplant Recipients with Hepatitis C by Direct-Acting Antiviral Therapy: A Report on Three Cases

Tojimbara¹,

Yashima²,

Shirai³

et al. 2017

J Clin Exp Nephrol

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We evaluated the efficacy of direct-acting antiviral (DAA) therapy in the management of renal transplant recipients with hepatitis C virus (HCV) infection. Methods:We treated two of our renal transplant recipients (Patients 1 and 2) who were HCV-RNA-(genotype 1b) positive with daclatasvir and asunaprevir. Another recipient (Patient 3), who was positive for HCV (genotype 2b), was treated with sofosbuvir and ribavirin. Patient 1 received DAA treatment following unsuccessful pegylated-interferon therapy. Prior to DAA therapy, his HCV-RNA level was 6.0 log IU/mL. After 8 weeks of treatment, DAA therapy was discontinued due to allograft dysfunction. In Patient 2, HCV-RNA level before DAA therapy was 6.9 log IU/mL. In Patient 3, DAA therapy was initiated 4 months after renal transplantation, when the patient's HCV-RNA level was 7.4 log IU/mL. Results:In all cases, HCV-RNA was undetectable within 4 weeks of the initiation of DAA therapy and a sustained virological response was maintained. In Patient 1, transient deterioration of renal function gradually recovered. Patient 3 developed BK virus nephropathy (BKN) 5 weeks after completion of DAA therapy, although the relationship between DAA and BKN remains unclear. Conclusion:DAA therapy was successful in the therapeutic management of our three HCV-infected renal transplant patients. Although physicians should be aware of the possibility of complex drug interactions, DAA therapy under such conditions may provide promising short-term outcomes.

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“…UNOS only collects HCV serological data; viral loads for both donors and recipients were not available and we could not distinguish between donors or recipients with active viremia and those who spontaneously cleared the virus or received HCV treatment with a sustained virologic response. However, given the low HCV treatment rates among dialysis patients [3], it is reasonable to assume that most HCV seropositive recipients have active HCV viremia. HCV genotype information was also not available, making it impossible to identify those with HCV superinfection.…”

Section: Discussionmentioning

confidence: 99%

“…Direct-acting antivirals (DAAs) were introduced for the treatment of HCV infection in 2013, but despite this advance in HCV therapy, the majority of patients remain untreated [3]. …”

Section: Introductionmentioning

confidence: 99%

Effect of kidney donor hepatitis C virus serostatus on renal transplant recipient and allograft outcomes

Cohen

Eddinger

Shelton

et al. 2017

Clinical Kidney Journal

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BackgroundHepatitis C virus (HCV) infection is common in dialysis patients and renal transplant recipients and has been associated with diminished patient and allograft survival. HCV-positive (HCV+) kidneys have been used in HCV-positive (HCV+) recipients as a means of facilitating transplantation and expanding the organ donor pool; however, the effect of donor HCV serostatus in the modern era is unknown.MethodsUsing national transplant registry data, we created a propensity score–matched cohort of HCV+ recipients who received HCV-positive donor kidneys compared to those transplanted with HCV-negative kidneys.ResultsTransplantation with an HCV+ kidney was associated with an increased risk of death {hazard ratio [HR] 1.43 [95% confidence interval (CI) 1.18–1.76]; P < 0.001} and allograft loss [HR 1.39 (95% CI 1.16–1.67); P < 0.001] compared with their propensity score–matched counterparts. However, HCV+ kidneys were not associated with an increased risk of acute rejection [odds ratio 1.16 (95% CI 0.84–1.61); P = 0.35].ConclusionsWhile use of HCV+ donor kidneys can shorten the wait for renal transplantation and maximize organ utility for all candidates on the waiting list, potential recipients should be counseled about the increased risks associated with HCV+ kidney.

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Interventions for dialysis patients with hepatitis C virus (HCV) infection

Cited by 6 publications

References 12 publications

Successful Treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents

Successful Treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents

Successful Management of Renal Transplant Recipients with Hepatitis C by Direct-Acting Antiviral Therapy: A Report on Three Cases

Effect of kidney donor hepatitis C virus serostatus on renal transplant recipient and allograft outcomes

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