Efficacy and tolerability of interferon-free antiviral therapy in kidney transplant recipients with chronic hepatitis C

Fecha de publicación: 01/04/2017

Autores de IIS La Fe

Martín Prieto Castillo

Autor

Participantes ajenos a IIS La Fe

Fernández I
Muñoz-Gómez R
Pascasio JM
Baliellas C
Polanco N
Esforzado N
Arias A
Castells L
Cuervas-Mons V
Hernández O
Crespo J
Calleja JL
Forns X
Londoño MC

Grupos

Hepatología experimental y Trasplante hepático

Investigador Principal

Laia Tolosa Pardo

Abstract

Background & Aims: The development of direct-acting antiviral agents (DAAs) is a major step forward in the treatment of hepatitis C (HCV). The aims of the study were to evaluate the efficacy and tolerability of DAAs in kidney transplant (KT) recipients. Methods: Hepa-C is a Spanish registry of patients treated with DAAs in which clinical, virological and analytical data were prospectively included. We report on the data from 103 KT recipients who received DAAs. Results: The most commonly used DAAs combinations were sofosbuvir/ledipasvir (n = 59, 57%) and sofosbuvir + daclatasvir (n = 18, 17%). Ribavirin was used in 41% of patients. Sustained viral response after 12 weeks (SVR12) rate was 98%. Grade 2 or 3 anemia appeared in 14 (33%) of patients receiving ribavirin and in 9 (15%) without (p = 0.03). There were three episodes of acute humoral graft rejection. No patient discontinued therapy due to adverse events. Importantly, 57 (55%) patients required immunosuppression dose adjustment. Overall, there were no statistically significant differences in the mean level of serum creatinine, eGFR and proteinuria before and after treatment. Nonetheless, seventeen (16%) patients experienced renal dysfunction (increase in serum creatinine >25%) during antiviral therapy, of whom 65% were cirrhotic in comparison with only 29% cirrhotic patients who did not develop significant renal dysfunction (p = 0.004). Conclusions: Antiviral therapy with DAAs was highly efficacious and safe in KT recipients. Nevertheless, a non-negligible number of patients, most of them cirrhotic, developed mild allograft dys-function and a significant proportion of patients required immunosuppression dose adjustment, warranting a close follow-up during therapy. Lay summary: Infection by hepatitis C virus is often found in kidney transplant patients and its presence increases mortality and graft failure. We investigated the efficacy and safety of the new direct-acting hepatitis C antivirals in this population, in which previous information is scarce. Our data shows that, as occurs in the non-transplant setting, new anti-HCV antivirals are highly efficacious kidney transplant patients. Overall, this therapy is also quite safe, although worsening of renal function is observed in 16% of patients warranting a close follow-up observation of graft function during antiviral therapy. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.

Datos de la publicación

ISSN/ISSNe:: 0168-8278, 1600-0641
Tipo:: Article
Páginas:: 718-723
DOI:: 10.1016/j.jhep.2016.12.020
Factor de Impacto:: 5,633 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Filiaciones

Fernández I:: Digestive Disease Service, Hospital Universitario 12 de Octubre, Madrid, Spain
Muñoz-Gómez R:: Digestive Disease Service, Hospital Universitario 12 de Octubre, Madrid, Spain
Pascasio JM:: Digestive Disease Service, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, Spain
Baliellas C:: Digestive Disease Service, Liver Transplant Unit, Hospital Universitari de Bellvitge IDIBELL, Barcelona, Spain
Polanco N:: Nephrology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
Esforzado N:: Nephrology Department, Hospital Clinic Barcelona, Barcelona, Spain
Arias A:: Internal Medicine Hospital Universitario Puerta de Hierro, IDIPHIM, CIBERehd, Majadahonda, Madrid, Spain
Prieto M:: Liver Unit, Digestive Medicine Service, Hospital Universitari i Politecnic La Fe, CIBERehd, Valencia, Spain
Castells L:: Liver Unit Internal Medicine Department, Hospital General Universitari Vall d' Hebron, CIBERehd, Barcelona, Spain
Cuervas-Mons V:: Internal Medicine Hospital Universitario Puerta de Hierro, IDIPHIM, CIBERehd, Majadahonda, Madrid, Spain
Hernández O:: Digestive Disease Service, Hospital Universitario 12 de Octubre, Madrid, Spain
Crespo J:: Gastroenterology and Hepatology Unit. Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain
Calleja JL:: Liver Unit, Hospital Universitario Puerta de Hierro, IDIPHIM, CIBERehd, Majadahonda, Madrid, Spain
Forns X:: Liver Unit, Hospital Clínic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
Londoño MC:: Liver Unit, Hospital Clínic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain