Introduction: Hepatitis C virus (HCV) infection is associated with increased risk of mortality in kidney transplant (KT) recipient as a consequence of graft failure, progressive liver disease and cardiovascular disease. The introduction of direct-acting antivirals (DAAs) has revolutionized the treatment of HCV with high cure rates and low rates of adverse events. The aims of this study were to evaluate the efficacy and tolerability of DAAs in KT recipients.
Materials and Methods:  We report on data from ten KT recipients chronically infected with HCV treated with DAAs in our center. The decision to treat and the choice of DAAs was determined according to the regulations considered by ministry of health.  
Results: The patients were predominantly male (n=6) and median age was 50.5 years. Seven patients had undergone cadaveric KT. Most patients (n=7) were infected with genotype 1b. Cirrhosis was present in only 2 patients. Eight patients received ombitasvir-paritaprevir-ritonavir and dasabuvir combination therapy for 12 weeks and the others underwent treatment with sofosbuvir and ledipasvir for 24 weeks. Ribavirin was used in non-cirrhotic two patients infected with genotype 1a. Two patient discontinued therapy due to adverse events. Nine patients cleared the virus at the end of the treatment. Sustained virologic response after 12 weeks was achieved in 90% of the patients. Importantly, 5 patients required immunosuppression dose adjustment. Two patients experienced renal dysfunction during antiviral therapy. Extensive skin rash and severe mucositis were observed in two patients.
Conclusion: Antiviral therapy with DAAs was highly efficacious in KT recipients with chronic hepatitis C. Nevertheless, drug interaction, revision of immunosuppressive dose and allograft dysfunction necessitate a close follow-up during therapy.