Safety and Efficacy of Treatment of Hepatitis C in Kidney Transplant Recipients with Directly Acting Antiviral Agents

Michelle Lubetzky, Soohwan Chun, Andrew Joelson, Maria Coco, Layla Kamal, Maria Ajaimy, Paul Gaglio, Enver Akalin, Graciela Deboccardo

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

BACKGROUND: With the development of all oral, interferon-free directly acting antiviral (DAA) medications, treatment of Hepatitis C infection (HCV) in renal transplant recipients is possible, but limited data exists on its safety and efficacy. METHODS: We performed a retrospective cohort analysis of patients transplanted at our center with HCV who have been started on DAAs. Primary endpoints included sustained virologic response (SVR) as defined as negative viral load at 12 weeks post completion of therapy and allograft function. RESULTS: A total of 31 patients met inclusion criteria. The most commonly used regimen was sofosbuvir and ledipasvir (n=21). Of the treated patients, 100% had undetectable viral load at the completion of therapy. Of the 31 patients treated, 30 (97%) achieved SVR. Both graft and patient survival at most recent follow up was 100%. There was no significant change in glomerular filtration rate (GFR) before or after therapy (64.2±16.5 ml/min/BSA before vs. 58.9±17.5 ml/min/BSA after therapy, p=0.22), however, 3 patients now have GFR<20. A total of 6/31 (19.3%) patients had worsening proteinuria during or shortly after therapy. Patients with more than 500mg/g of proteinuria at the start of treatment were significantly more likely to develop worsening proteinuria than those with less than 500mg/g of proteinuria at the start of therapy (p<0.001). Retrospective review of 20 untreated HCV patients did not demonstrate worsening allograft function and proteinuria during a median follow up time of 1386 days (range 332, 6254). CONCLUSIONS: Our preliminary data demonstrate that DAAs can be used safely and effectively in patients after kidney transplantation. Patients with proteinuria or lower GFR should be monitored more closely.

Original languageEnglish (US)
JournalTransplantation
DOIs
StateAccepted/In press - Dec 22 2016

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Hepatitis C
Antiviral Agents
Kidney
Safety
Proteinuria
Glomerular Filtration Rate
Therapeutics
Viral Load
Allografts
Transplant Recipients
Graft Survival
Kidney Transplantation
Interferons
Cohort Studies

ASJC Scopus subject areas

  • Transplantation

Cite this

Safety and Efficacy of Treatment of Hepatitis C in Kidney Transplant Recipients with Directly Acting Antiviral Agents. / Lubetzky, Michelle; Chun, Soohwan; Joelson, Andrew; Coco, Maria; Kamal, Layla; Ajaimy, Maria; Gaglio, Paul; Akalin, Enver; Deboccardo, Graciela.

In: Transplantation, 22.12.2016.

Research output: Contribution to journalArticle

Lubetzky, Michelle ; Chun, Soohwan ; Joelson, Andrew ; Coco, Maria ; Kamal, Layla ; Ajaimy, Maria ; Gaglio, Paul ; Akalin, Enver ; Deboccardo, Graciela. / Safety and Efficacy of Treatment of Hepatitis C in Kidney Transplant Recipients with Directly Acting Antiviral Agents. In: Transplantation. 2016.
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abstract = "BACKGROUND: With the development of all oral, interferon-free directly acting antiviral (DAA) medications, treatment of Hepatitis C infection (HCV) in renal transplant recipients is possible, but limited data exists on its safety and efficacy. METHODS: We performed a retrospective cohort analysis of patients transplanted at our center with HCV who have been started on DAAs. Primary endpoints included sustained virologic response (SVR) as defined as negative viral load at 12 weeks post completion of therapy and allograft function. RESULTS: A total of 31 patients met inclusion criteria. The most commonly used regimen was sofosbuvir and ledipasvir (n=21). Of the treated patients, 100{\%} had undetectable viral load at the completion of therapy. Of the 31 patients treated, 30 (97{\%}) achieved SVR. Both graft and patient survival at most recent follow up was 100{\%}. There was no significant change in glomerular filtration rate (GFR) before or after therapy (64.2±16.5 ml/min/BSA before vs. 58.9±17.5 ml/min/BSA after therapy, p=0.22), however, 3 patients now have GFR<20. A total of 6/31 (19.3{\%}) patients had worsening proteinuria during or shortly after therapy. Patients with more than 500mg/g of proteinuria at the start of treatment were significantly more likely to develop worsening proteinuria than those with less than 500mg/g of proteinuria at the start of therapy (p<0.001). Retrospective review of 20 untreated HCV patients did not demonstrate worsening allograft function and proteinuria during a median follow up time of 1386 days (range 332, 6254). CONCLUSIONS: Our preliminary data demonstrate that DAAs can be used safely and effectively in patients after kidney transplantation. Patients with proteinuria or lower GFR should be monitored more closely.",
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AU - Coco, Maria

AU - Kamal, Layla

AU - Ajaimy, Maria

AU - Gaglio, Paul

AU - Akalin, Enver

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AB - BACKGROUND: With the development of all oral, interferon-free directly acting antiviral (DAA) medications, treatment of Hepatitis C infection (HCV) in renal transplant recipients is possible, but limited data exists on its safety and efficacy. METHODS: We performed a retrospective cohort analysis of patients transplanted at our center with HCV who have been started on DAAs. Primary endpoints included sustained virologic response (SVR) as defined as negative viral load at 12 weeks post completion of therapy and allograft function. RESULTS: A total of 31 patients met inclusion criteria. The most commonly used regimen was sofosbuvir and ledipasvir (n=21). Of the treated patients, 100% had undetectable viral load at the completion of therapy. Of the 31 patients treated, 30 (97%) achieved SVR. Both graft and patient survival at most recent follow up was 100%. There was no significant change in glomerular filtration rate (GFR) before or after therapy (64.2±16.5 ml/min/BSA before vs. 58.9±17.5 ml/min/BSA after therapy, p=0.22), however, 3 patients now have GFR<20. A total of 6/31 (19.3%) patients had worsening proteinuria during or shortly after therapy. Patients with more than 500mg/g of proteinuria at the start of treatment were significantly more likely to develop worsening proteinuria than those with less than 500mg/g of proteinuria at the start of therapy (p<0.001). Retrospective review of 20 untreated HCV patients did not demonstrate worsening allograft function and proteinuria during a median follow up time of 1386 days (range 332, 6254). CONCLUSIONS: Our preliminary data demonstrate that DAAs can be used safely and effectively in patients after kidney transplantation. Patients with proteinuria or lower GFR should be monitored more closely.

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