Use of direct-acting agents for hepatitis C virus-positive kidney transplant candidates and kidney transplant recipients

Abstract

In some parts of the world, hepatitis C virus (HCV) infection remains a huge problem for kidney transplant candidates and kidney transplant (KT) recipients. Until 2 years ago, anti-HCV treatment for the general population relied on pegylated alpha-interferon plus ribavirin, but led to a sustained viral response (SVR) in <50% of cases. This treatment was contraindicated in KT patients because of acute-rejection issues and was poorly tolerated in patients with end-stage renal disease (ESRD). Over the last year, direct-acting antiviral agents (DAAs) have entered the market and are associated in the general population with a SVR of >90%, whatever the patient's HCV genotype. In KT patients, sofosbuvir-based therapy is associated with a SVR at nearly 100% in patients with a HCV genotype-1 infection, with almost no side effects and only mild interference with immunosuppressive drugs. Most HCV(+) patients with ESRD are genotype 1: in that setting, a recent study reported that the association of grazoprevir/elbasvir 100/50 mg/day led to a SVR of nearly 95% with very few side effects. Thus, it is concluded that DAAs can be safely used and lead to results in KT candidates and KT patients that are as good as those observed in the nonrenal population.

Impact of anti-HCV direct antiviral agents on graft function and immunosuppressive drug levels in kidney transplant recipients: a call to attention in the mid-term follow-up in a single-center cohort study

“…This dismal scenario has dramatically changed with the advent of direct antiviral agents (DAAs), allowing the design of all‐oral IFN‐α‐free regimens . Sofosbuvir (SOF) is a pan‐genotypic nucleotide analog with a potent inhibitory effect on the viral NS5B polymerase .…”

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

“…Böbrek nakli sonrası HCV tedavisinde ise IFN kullanmak mümkün olmuyordu. Çünkü IFN immün sistemi aktive ederek akut rejeksiyon riski ortaya çıkarıyordu (2,3). Özellikle son 4 yılda birçok araştırma ile etkinliği kanıtlanan direkt etkili antiviral kombinasyonlar ise HCV enfeksiyonunun uzun süreli tedavisini, hatta eradikasyonunu mümkün kıldı.…”

“…Yeni çıkan direkt etkili antiviral ilaçların kullanıma girmesi ile nakil sonrası HCV tedavisinde büyük aşama elde edilmiş-tir. Nakil öncesi mevcut olan HCV için viral yükün ortadan kaldırılması tercih edilmektedir (1,2). Böbrek nakli sonrası dönemde gösterilen HCV enfeksiyonunun tedavisi ise daha özenli bir yaklaşım gerektirir.…”

Hepatitis C and renal transplantation in era of new antiviral agents

“…Rostaing et al[ 74 ] recently reviewed the treatment of HCV infection in kidney transplant candidates with poor renal function or on dialysis. Saxena et al[ 75 ] reported the efficacy of sofosbuvir in association with ribavirin in 73 patients with an eGFR < 45 mL/min, and SVR was achieved in 83% of patients.…”