Background: Chronic Hepatitis C Virus (HCV) infection has a negative impact on graft survival. Prior treatments were poorly tolerated and had minimal cure rates. The efficacy and safety of Direct Acting Anti-Virals (DAAs) for HCV treatment is currently being studied in kidney transplant recipients.

Methods: Our institutional database was queried for all kidney transplant recipients who had received DAAs. Thirty patients with kidney transplants referred for treatment of HCV were retrospectively reviewed for their demographics and efficacy.

Results: There were 21 males, 15 African-American, 1 Asian and 14 Caucasian, 7 combined liver-kidney with a mean age of 60.0 +/- 8.4 years. 25 cases (83.3%) were of genotype 1a. 7/30 patients got treatment with Interferon before Transplant while 23 were naïve. Liver Biopsy was performed in 24 patients, 21 patients had mild to moderate fibrosis (F0-F2). The median pre-treatment HCV viral load (VL) was 4,655,000. All patients continued with immunosuppression therapy adjusted according to their graft function. Four patients received Sofosbuvir(SOF)+Ribavarin (RBV), 7 received SOF+Simeprevir (SIM), 1 received SOF+SIM+RBV , 4 cases received SOF+Ledipasvir(LED) without RBV ,13 cases received SOF+LED+RBV , 1 case received Viekira (Ombitasvir+Paritaprevir+Ritonavir+Dasabuvir).

Median duration from transplant to start of therapy was 20.9 months. Mean duration of therapy was 3.5+/- 1.3 months. Mean post-treatment AST, ALT were significantly lower at end of treatment (p<0.05) with no significant change in other liver or renal parameters including eGFR or proteinuria. End of treatment Response was 28/30 (93.3%) of cases. SVR12 was noted in 27/30 (90.0%). There was 1 case of early discontinuation. Aside from RBV induced anemia, there were no other new safety signals.

Conclusion: We report our large series of DAA HCV treatment in kidney transplantation with excellent safety, tolerability and success. Further large studies are needed to confirm our findings and define the appropriate population for treatment.

CITATION INFORMATION: Hussain S, Taber T, Yaqub M, Adebiyi O, Mishler D, Sharfuddin A. Efficacy and Safety of Direct Acting Antivirals in Kidney Transplant Recipients with Chronic Hepatitis C Virus Infection. Am J Transplant. 2017;17 (suppl 3).

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