Abstract: SA-PO497
Effectiveness of Direct-Acting Antiviral Regimens in the Treatment of Hepatitis C Virus (HCV) in Kidney Transplant Recipients
Session Information
- Transplantation: Balancing Rejection and Infection
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Horn, Karolyn S., University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
- Campara, Maya, University of Illinois Hospital and Health Sciences System / University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, United States
- Martin, Michelle T., University of Illinois Hospital and Health Sciences System / University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, United States
- Tang, Ignatius Yun-Sang, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
Background
The AASLD Hepatitis C virus (HCV) guidance document does not offer recommendations for the treatment of kidney transplant recipients. Real-world data are needed to evaluate the effectiveness of direct-acting antivirals (DAAs) in this underrepresented population.
Methods
Authors performed a retrospective chart review of kidney transplant recipients (KTRs) who were treated for HCV at an urban medical center from January 1, 2014 to December 1, 2016. This reports[M1] our single-center, retrospective analysis of the efficacy and safety of DAA-based regimens in kidney (K), kidney-liver (KL), and kidney-pancreas (KP) transplant patients.
Results
28 KTRs were treated for HCV; 54% were K, 32% KL, and 14% KP. Patients had a mean age of 60 (+7) years, 50% were male, 71% were treatment naïve, 25% had cirrhosis, and all GT 1. Pre-treatment and end-of-treatment levels did not differ for serum creatinine (n=22 patients, 1.5mg/dL vs 1.7mg/dL,p=0.4); or urine microalbumin to creatinine ratio (n=15 patients, 337.3 vs 111, p=0.3). 18% had dose changes in immunosuppression (IMS) levels during and after HCV treatment, but the mean daily tacrolimus levels did not differ from baseline and 12 weeks after treatment completion (4.6 mg vs 4.8 mg, respectively, p>0.05). The overall SVR rate was 86%. SVR did not differ by regimen; 50% with sofosbuvir+ribavirin, 90.9% with sofosbuvir+simeprevir, 90% with ledipasvir/sofosbuvir, 75% ledipasvir/sofosbuvir + ribavirin, and 100% with elbasvir/grazoprevir achieved SVR (p=0.55). SVR did not differ by type of transplant (92.9% K vs 80% KL vs 75% KP, p = 0.54). SVR also did not differ by genotype, gender, ethnicity, BMI, baby-boomer status, cirrhosis, treatment history, adherence, or diabetes (p>0.05). SVR did differ by primary IMS agent, SVR rates were 100% for mycophenolate mofetil (n=1), 91.7% for tacrolimus (n=24), 100% for sirolimus (n=1), and 85.7% for cyclosporine (n=2) (p=0.005).
Conclusion
DAA regimens were highly effective in treating HCV in KTRs. Renal allograft function was stable throughout and 12 weeks after DAA therapy. Comparison across groups was limited due to small numbers. IMS levels should be monitored closely during HCV treatment as many patients required dose adjustments.