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Abstract Details
Chronic Hepatitis C Virus Infection After Kidney Transplantation With or Without Direct-Acting Antivirals in a Real-Life Setting: A French Multicenter Experience
Transplant Proc. 2020 Jul 4;S0041-1345(20)32581-1. doi:10.1016/j.transproceed.2020.06.005.Online ahead of print.
Eloi Chevallier1, Matthias Büchler2, Sophie Caillard3, Nicolas Bouvier4, Charlotte Colosio5, Joseph Rivalan6, Johnny Sayegh7, Dominique Bertrand8, Yannick Le Meur9, Antoine Thierry10, Cyril Garrouste11, Jean-Philippe Rerolle12, Lionel Rostaing13, Philippe Gatault2
Author information
1Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, CHU Grenoble-Alpes, Grenoble, France; Grenoble-Alpes University, Grenoble, France.
2Department of Nephrology and Clinical Immunology, CHU Tours, Tours, France.
3Department of Nephrology, Strasbourg University Hospital, Strasbourg, France.
4Department of Nephrology, Caen University Hospital, Caen, France.
5Department of Nephrology, Reims University Hospital, Reims, France.
6Department of Nephrology, Rennes University Hospital, Rennes, France.
7Department of Nephrology, Angers University Hospital, Angers, France.
8Department of Nephrology, Rouen University Hospital, Rouen, France.
9Department of Nephrology, Brest University Hospital, Brest, France.
10Department of Nephrology, Poitiers University Hospital, Poitiers, France.
11Department of Nephrology, Clermont Ferrand University Hospital, Clermont Ferrand, France.
12Department of Nephrology, Limoges University Hospital, Limoges, France.
13Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, CHU Grenoble-Alpes, Grenoble, France; Grenoble-Alpes University, Grenoble, France. Electronic address: lrostaing@chu-grenoble.fr.
Abstract
Purpose: Kidney transplant recipients (KTRs) are frequently infected with chronic hepatitis C virus (HCV), which can increase the risk of graft loss. Active HCV infections among KTRs are associated with shorter survival times. The emergence of very efficient interferon-free treatments (direct-acting antivirals [DAAs]) has revolutionized prognoses for chronic viral hepatitis. We performed a multicenter study where HCV (+)/RNA (+) KTRs were followed up and either received DAAs (group A) or not (group B) according to the transplant center. The aim was to assess, in a real-life setting, the impact of DAA therapy and to compare these results with those from HCV RNA (+) KTRs where HCV infection was not treated during the same period.
Methods: This study included 66 patients from 11 centers: 44 patients (66.7%; group A) received DAAs, whereas 22 patients did not (group B); the 2 groups were comparable according to baseline data. Most patients (88.6%) received sofosbuvir, 50% received ledipasvir, and 34.7% received daclatasvir. The duration of treatments ranged from 8 to 24 weeks.
Results: HCV RNA clearance (ie, a sustained virologic response) was observed in 95.4% of treated patients. Eradication of HCV led to a significant decrease in liver enzymes (50% reduction for alanine aminotransferase [P ≤ .001] and 41% for gamma glutamyl transpeptidase [P < .001]). Conversely, liver enzymes did not decrease in group B. Death occurred significantly more frequently in nontreated than treated patients (3 in group B vs none in group A, P = .003). Of the 10 treated patients with severe renal impairment before DAA therapy, 6 experienced graft loss.
Conclusion: DAAs are very effective at treating chronic HCV and have an excellent tolerance profile.