Hepatitis C Virus Infection in Kidney Transplant Recipients: Final Results from a Spanish Multicenter Study
Carmen Gonsalez-Corvillo1, Juan Carlos Ruiz San Millan2, Jordi Espi Reig8, Angel Alonso19, Alberto Rodriguez Benot13, Domingo Hernandez4, Marta Crespo Barrio3, Ana Sanchez Fructuoso18, Ricardo Lauzurica11, Antonio Franco19, Auxiliadora Mazuecos14, Carmen Cantarell10, Sofia Zarraga7, Luis Guirado9, Luisa Jimeno12, Carmen Diaz-Corte5, M. Carmen Gracia Guindo19, Miguel Angel Gentil Govantes1.
1Kidney Transplant, Hospital Virgen De Rocio, Sevilla, Spain; 2Kidney Transplant, Hospital Marques De Valdecillas, Santander, Spain; 3Kidney Transplant, Hospital Del Mar, Barcelona, Spain; 4Kidney Transplant, Hospital Carlos Haya, Malaga, Spain; 5Kidney Transplant, Hospital Central De Asturias, Oviedo, Spain; 6Kidney Transplant, Hospital De Alicante, Alicante, Spain; 7Kidney Transplant, Hospital De Cruces, Vizcaya, Spain; 8Kidney Transplant, Hospital La Fe, Valencia, Spain; 9Kidney Transplant, Fundacion Puigvert, Barcelona, Spain; 10Kidney Transplant, Hospital Vall D. Hebron, Barcelona, Spain; 11Kidney Transplant, Hospital German Trias I Pujol, Barcelona, Spain; 12Kidney Transplant, Hospital Virgen De Arraixaca, Murcia, Spain; 13Kidney Transplant, Hospital Reina Sofia, Cordoba, Spain; 14Kidney Transplant, Hospital Puerta Del Mar, Cadiz, Spain; 15Kidney Transplant, Complejo Hospitalario De A Coruña, A Coruña, Spain; 16Kidney Transplant, Hospital Miguel Servet, Zaragoza, Spain; 17Kidney Transplant, Hospital La Paz, Madrid, Spain; 18Kidney Transplant, Clinico San Carlos, Madrid, Spain; 19Kidney Transplant, Hospital Virgen De Las Nieves, Granada, Spain
Grupo Español De Actualizacion En Trasplante.
Background: HCV is a relevant negative prognosis factor for graft and transplant recipient survival.New direct-acting antivirals(DAA)allow us to solve this problem in an effective way.It is crucial to know their real impact in our daily practice.
Methods: Observational,retrospective and prospective study.We analyze treatment results with DAA,in kidney transplant(KT)recipients from 15 hospitals,regarding effectiveness,tolerance and impact on immunosuppression and renal function-proteinuria in a short-medium term.
Results: Until November 2017,226 KT recipients were included(9combined liver- kidney transplants).69.7%male;average age 54.2±9yo;KT length 11.4±10years. More than 50%showed stage 3-4 chronic kidney disease.Immunosuppressive therapies:tacrolimus(70%) or cyclosporine(18%)with MMF(76%).Predominant genotype was 1b(68.1%),1a(13.8%),3(7.8 %),4(6%) and 2(4.3%);51% had grade 3-4 of fibrosis,17%portal hypertension.The main DAA used was sofosbuvir(91%)combined with ledipasvir(55%),simeprevir(14%)or daclatasvir(13%);in 9 cases(7%)the combination of paritaprevir-ritonavir-ombitasvir-dasabuvir(3D)was employed;18% were treated with Ribavirin as coadjuvant.Side effects were limited,23.5 %,and without relevance,except for anemia caused by Ribavirin.2 patients interrupted the treatment,due to neurotoxicity caused by the interaction between 3D and tacrolimus and anemia caused by Ribavirin(both had virological response).All the patients that completed the treatment(213)are alive and show virological response in 98% of cases and with SVR-12.Liver function analysis improved:74%normal vs 21%before the treatment(p<0.001).Renal function did not change significantly.Tacrolimus level at the end was lower with respect to the beginning(6.6 vs 7.3 ng/ml,p=0.03),in spite of a slight increase in the dose(3.5 vs 2.6 mg/day p=0.01).
Conclusions: DAA are highly effective in KT patients,with good tolerance,making it possible to solve the problem and having a good chance to improve the prognosis in our patients.The use of DAA in these patients requires special control and coordination with hepatologists,especially when 3D or Ribavirin is used.
