HCV infection is associated to chronic hepatitis, cirrhosis, hepatic carcinoma and increased incidence of diabetes. Combination of new antiviral drugs have demonstrated utility in liver transplant recipients.

Our aim was to evaluate safety and efficacy of the association of new direct-acting antivirals drugs (DAAs) in renal transplant recipients.

We included 16 renal transplant recipients according to this criteria: liver enzimes ≥ 3 folds, detectable viral load, stable renal function, liver damage (Metavir > 2) without esophageal varices. For statistical analysis t Student test with p<0.05 was used.

12 male and 4 female were included, media age 54.7 + 10.4 years. 5/16 were re-transplant. 13/16 were DD recipients and 3 LD (2 unrelated). All were HCV positive in waiting list but only 4 patient had history of had been treated with interferon/ribavirin during pre transplant period in order to can be transplanted.

According to the treatment of HCV 13/16 (group A), they were treated with sofosbovir / daclatasvir (400/60 mg / d) while 3/16 (group B) received ombitasvir / paritrapevir / ritonavir / dasabuvir -Viekira Pak- (6 tab) / d) according to GFR. 11/16 cases were treated during 12 weeks and 24 weeks for remaining 5.

Time of transplant up to treatment was 97 month (range 6 to 244 month). Related to inmmunosupression, 6 received tacrolimus, 13 MMF, 6 Sirolimus, 6 Belatacept and all of patient had low steroids dose.

The most common genoma finding was 1b (12/16) and the rest 1a.

Viral load range from 1.200.000 to 29.000.000 copies pre treatment and is undetectable from the end of the treatment up to now (mean follow up 1 year), as well as normalizing liver enzymes. Only patients treated with Viekira needed up to 70% decrease of tacrolimus or sirolimus doses.

Both treatments were well tolerated and no discontinuations were seen.

During a mean follow up of 1 year (range 1 – 24 month), 1 patient (groups A) developed rejection episode unsuccefully treated (patient retransplanted, pre- sensitized) with graft loss 18 mo after HCV treatment. The other patients have stable renal function without proteinuria (mean MDRD 64.9 ml/min).

Conclusion: In spite of low cases analyzed, HCV infection treatment with DAAs in renal transplant recipients was both effective and safe. Daclatasvir/sofosbuvir shows same efficacy as Viekira l, but management is easiest in patients who receive tacrolimus or sirolimus because of lack of drug interactions.

CITATION INFORMATION: Rial M., Tana L., Alonso C., Curcio H., Chulluyan E., Casadei D. Treatment of HCV Infection in Renal Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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