Date: Saturday, May 30, 2020
Session Name: Poster Session C: Non-Organ Specific: Viral Hepatitis
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Our previous data showed that transplantation of kidneys from hepatitis C virus (HCV) infected donors to HCV negative recipients achieved excellent short-term graft function, but relatively high rates of BK, CMV viremia, and de novo DSA, which may be avoidable with very early treatment initiation or prophylactic treatment of HCV. Ezetimibe acts as an antagonist at NPC1L1 receptor, which is required for entry of HCV via a virion cholesterol-dependent step and inhibits infection by all major HCV genotypes in vitro. However, there are no published data showing the use of ezetimibe as a treatment or prophylactic agent in kidney transplants from HCV infected donors to non-infected recipients.
*Methods: This single center, prospective cohort study included 59 HCV negative kidney transplant recipients, who received an HCV infected (NAT+) kidney and were followed for 4 weeks from the day of transplant. Twenty patients received Ezetimibe 10 mg daily starting post-operative day zero while 39 patients did not. Our patients were tested for HCV RNA and HCV genotype at 4 weeks post-transplant and started on a DAA regimen for at least 12 weeks.
*Results: The median recipient age was 57 (interquartile range (IQR): 48-62) years, 38 (64%) were male and 48 (81%) were African-Americans. The median value of the highest viral load was found to be one log lower in the ezetimibe group (median: 4.29; interquartile range (IQR) 3.75-5.44 IU/mL) than the non-ezetimibe group (median: 5.50; IQR: 5.09-6.21 IU/mL, p=0.04). In addition, the median value of the mean viral load was also found to be more than one log lower in the ezetimibe group (median: 3.99; interquartile range (IQR) 3.75-5.27 IU/mL) than the non-ezetimibe group (median: 5.50; IQR: 5.09-6.21 IU/mL, p=0.03). However, median of mean ALT (44; IQR: 28-55 IU/L) and mean AST (22; IQR: 17- 31 IU/L) in the ezetimibe group was not different from the non-ezetimibe group (ALT: 41; IQR: 28-71 IU/L, p=0.76) and (AST: 23; IQR: 18-39 IU/L, p=0.58), respectively.
*Conclusions: Ezetimibe use in transplantation of kidneys from HCV-infected donors to HCV-negative recipients is associated with a significantly lower level of post-transplant HCV viremia.
To cite this abstract in AMA style:Azhar A, Yazawa M, Talwar M, Balaraman V, Bhalla A, Agbim UA, Maliakkal B, Kothadia JP, Nair S, Eason JD, Molnar MZ. Association between Ezetimibe Usage and Hepatitis C RNA Levels in Uninfected Kidney Transplant Recipients Who Received Hepatitis C Infected Kidneys [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/association-between-ezetimibe-usage-and-hepatitis-c-rna-levels-in-uninfected-kidney-transplant-recipients-who-received-hepatitis-c-infected-kidneys/. Accessed March 8, 2021.
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