Objective: Limited real world data exists regarding the use of direct acting antivirals (DAA) for HCV viremia in renal transplant patients, particularly those with marked renal insufficiency. Zepatier has been shown to be safe and effective in non-transplant patients with significant renal impairment. We assessed the efficacy and safety of Zepatier in post kidney transplant patients at an urban transplant center.

Methods: All kidney transplant recipients treated with Zepatier between June 2016 and July 2017 that were at least 12 weeks out from treatment were assessed. Background information collected included age, gender, race, BMI, stage of liver fibrosis, and prior hepatitis C treatment. Primary outcome was undetectable HCV RNA levels at post treatment week 12 (SVR12). Secondary outcomes included changes in renal function, changes in immunosuppression levels/dosing, and adverse events during and after treatment.

Results: 5 patients met inclusion criteria. The group was composed predominantly of treatment-experienced (60%) African American (80%) females (60%). 4 patients had genotype 1a and 1 patient had genotype 1b HCV. 4 patients had pre-treatment eGFR <60 mL/min and 2 <30 mL/min. Average time from transplant to treatment was 33.8 months (4-92). 3 (60%) patients were treated for 12 weeks and 2 (40%) patients were treated for 16 weeks. Pre-treatment fibrosis stages wer Metavir stage 1 (1), stage 3 (2) and stage 4 (2).

100% of patients achieved SVR12. All patients needed adjustments in their immunosuppression (tacrolimus and everolimus) during treatment. While some minor rise in creatinine was noted during treatment all patients returned to pre-treatment baseline creatinine by post treatment week 12 and 2 patients had improvement from baseline by post treatment week 12. No treatment related adverse events were noted. No rejection episodes were noted during the study time period.

Discussion: Zepatier was safe and effective in this cohort of patients for treatment of chronic HCV in the post renal transplant patient including those with significant renal impairment. Frequent monitoring of immunosuppression levels during treatment is advised however changes did not affect renal outcomes.

CITATION INFORMATION: Brown P., Venkat D. Elbasvir-Grazoprevir (Zepatier) is Effective and Safe for the Treatment of Chronic Hepatitis C (HCV) Genotype 1 Virus in the Post Kidney Transplant Patient Am J Transplant. 2017;17 (suppl 3).

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