Antiviral therapy of chronic HCV infection in kidney transplant recipient

Chronic HCV infection is a serious problem of kidney transplantation, limiting the effectiveness of this operation. Aim: to evaluate the efficacy and safety of direct-acting antiviral therapy (DAAT) in kidney graft recipients (KGR) with chronic hepatitis C (CHC). Methods: the study included 24 KGR with CHC who underwent DAAT. The mean age was 51.5±10.2 years (men 75%). The duration of post-transplant period at the beginning of therapy was 6.4±5.7 years, duration of HCV infection was 10.4±7.3 years. GFR was 58.9±18.9 ml/min/1.73 m2 (all above 30 ml/min/1.73 m2 by CKD-EPI). 50% of KGR had 1b genotype HCV. Level of HCV RNA reached 1.3×106 (6.8×104; 8.1×106) IU/ml). Half of the patients had F2 or F3 stage of fibrosis, liver cirrhosis (F4 on the METAVIR scale) was diagnosed in 8.3% of recipients. 5 patients received SOF 400 mg/day with DCV 60 mg/day and 15 mg/kg/day of RBV for 12 weeks, 14 patients received SOF+DCV for 12 weeks, and 5 patients for 24 weeks. The duration of follow-up period after the end of the therapy was 22.8±10.2 months. Results: aviremia was achieved in 100% pts after 8.3±3.4 weeks of DAAT. It was accompanied by a decrease in the levels of ALT (p<0.0001) and AST (p<0.001). Sustained virological response was observed in all patients after 12 and 24 weeks after the end of the therapy. The degree of liver fibrosis regressed from 11.7±5.1 kPa to 7.1±2.7 kPa (p<0,001) at 12 weeks after the end of therapy. During of DAAT, 2/3 of patients had a decrease of blood level of CNI: Cs - from 111.3±29.9 to 88.4±25.4 ng/ml (p<0.027), and Tac - from 7.5±1.3 to 5.3±1.5 ng/ml (p<0.001). Renal graft function remained stable, as well as the severity of proteinuria. There were no cases of serious complications of treatment, except for an episode of acute rejection. Conclusion: direct-acting antiviral agents are effective and save in renal transplant recipients with chronic HCV infection. The probability of reducing of the blood levels of CNI during treatment requires careful monitoring to avoid renal graft dysfunction.

трансплантация почки, хроническая HCV-инфекция, противовирусная терапия, kidney transplantation, chronic HCV infection, antiviral therapy

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