Reports of efficacy of Direct Acting Antiviral drugs (DAA) > 90% in treatment of chronic HCV genotype 1, [GT1, 12 wk Sustained Viral Response (SVR12)] led to initiating treatment of ESKD pts unable to tolerate interferon regimes. The Ruby 1 trial of Viekira Pak (Ombitasvir 25 mg, Paritaprevir 150 mg/Ritonovir 100 mg and Dasabuvir 250 mg) in CKD4-CKD5 showed 90% SVR12 (Pockros P et al, Gastro 2016;150). The C-Surfer trial reported 99% SVR 12 with Zepatier (Grazoprevir 100 mg, Elbasvir 50mg, Roth D, et al, Lancet 2015; 386). We report our center results of DAA treatment in HCV pts [ALD and advanced cirrhosis (AC)] with CKD5 on hemodialysis (HD).

METHODS: HD pts with active HCV comprised the study cohort. Fibroelastography (FE) was performed, excluded in AC and portal hypertension. HCV RNA, GT obtained at baseline, HCV RNA at 4 wks, treatment end, at SVR 12. CBC was done weekly at HD centers. Pts with GT1 with Viekira Pak (1 AC received 24 wks), and GT2 received Zepatier. All pts received weekly dose of Ribavirin (R) [10.5 mg/kg]. Pts hospitalized for decompensation were treated by one of the investigators (JK).

RESULTS: A total of 13 pts were enrolled, 12 males (92%), median age 60 yrs. CKD5 due to Hypertension in 7 (53%), Diabetes 5(38%), CNI toxicity 1 (8%). HCV GT1 in 93%, GT1a 8 (62%) GT1b 1 (8%), GT1a/1b 3 (23%) and all GT1 pts received Viekira Pak/R. 1 pt with GT2 received Zepatier/R. FE was performed in 8 pts [3 AC were excluded] and mean kPa was 11.8 (5.9-15.8). Mean HCV RNA 2.13 million IU/ml (16000-5.5 million IU/ml), mean Log ₁₀ 5.9 (4.2-6.7). One non compliant pt was excluded and analysis on 12 pts: 3 of 12 pts (25%) had AC: 1 with varices, ascites, liver cancer, 1 with varices, liver cancer, 1 with TIPS (ascites/encephalopathy). 2 pts had prior transplant, 1 Liver-kidney, 1 allograft failure had chronic HBV on Lamivudine. Adverse effects: headache, nausea, diarrhea transiently. 2 AC pts developed R-induced anemia, dose reduction, 1 cirrhosis pt with HCC developed ascites, encephalopathy, jaundice, 1 had encephalopathy and 1 pleural effusion on treatment. All 12 pts completed treatment achieving SVR12 (100%).

CONCLUSIONS: Results in this cohort, not reported in CKD5 pts with ALD and AC, shows excellent efficacy of DAA (100%). Decompensation in AC and R-induced anemia can occur but optimal management and continued DAA therapy will lead to SVR12, cure and transplantation.

CITATION INFORMATION: Korula J, Shah T, Ranger E, Barba E, Vu D, Naraghi R. Direct Acting Antiviral Drugs Are Highly Effective in Hepatitis C (HCV) Patients with End Stage Renal Disease (ESKD) and Advanced Liver Disease (ALD). Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress