Chronic hepatitis C (HCV) infection is an important clinical challenge after kidney transplantation. This is the initial report of a single-center experience with sofosbuvir-based HCV treatment after KT. Results: 38 patients initiated treatment: 34 completed, 3 are undergoing therapy and 1 discontinued. From the 33 with complete charts, 15 were female (45.5%), 22 caucasian (66.7%), 27 treatment näive (81.8%), 6 (18.2%) had cirrhosis, one had a combined kidney-liver transplant. Mean age was 52.2 ± 9.1 years. Median time from transplantation was 138.0 (13-476) months. HCV genotypes 1/1a/1b, 2 and 3 corresponded to 69.6%, 3.0% and 18.2%; and 3 (9.1%) genotypes were not registered. Mean viral load was log 6.28 ± 0.78. Therapy consisted of sofosbuvir and daclatasvir for 24 weeks in 1 (3%) patient, for 12 weeks in 27 patients (81.8%), and associated with ribavirin in 5 patients (15.2%). There was no statistical difference in eGFR during treatment using ANOVA (F(4,140) = 0.170, p = 0.953) (Table 1). There was a significant decrease in aminotransferases from baseline to treatment week 4, that remained throughout treatment (p < 0.05, data not shown). In 12/23 patients on calcineurin inhibitors the seric level decreased by more than 30%, and dosage adjustments were necessary. Treatment was well tolerated, with 5 cases of symptomatic anemia (4 with ribavirin, 3 discontinued the drug and 1 had hemotransfusion); depressive symptoms (2), atypical chest pain (1), myalgias and arthralgia (2) and headache (2) that did not require intervention. One patient had an acute rejection episode 2 months after the end of treatment that occurred in a context of low immunosuppression (low dose MPA and steroids), and returned to dialysis after 12 months. The patient that discontinued treatment had baseline fluctuating creatinine levels and decided to interrupt treatment; creatinine levels remain the same after one year. All patients had undetectable viral loads by the end of treatment and available results from 23/33 patients remain undetectable after 12 weeks. Conclusion: sofosbuvir-based HCV treatment was well tolerated after KT with sustained virological response. This is an initial experience report with encouraging results for the KT population.

CITATION INFORMATION: Garcia V., Meinerz G., da Silva C., Bruno R., Keitel E. Single-Center Experience with Sofosbuvir-Based HCV Treatment after Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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