*Purpose: Chronic Hepatitis C Virus (HCV) infection has a negative impact on graft survival. Prior treatments were poorly tolerated and had minimal cure rates. We examined our institutional experience with treating post-transplant HCV in Kidney Transplant Recipients.

*Methods: Our institutional database was queried for all kidney transplant recipients who had received DAAs. 47 patients with kidney transplants referred for treatment of HCV were retrospectively reviewed for their demographics and efficacy.

*Results: A total of 47 patients were treated from 2012 to 2018. There were 70% males, 48.9% African-Americans, 2 SKP and 7 combined liver-kidney with a mean age of 58.7 +/- 8.5 years. Majority (68%) were of genotype 1a with 25% 1b, and once case each of 2a,2b and 3. 25.5% patients got treatment with Interferon before Transplant while remaining 74.4% were treatment naïve. Liver Fibrosis score was F0=16, F1=12, F2=10 F3/4=6 in our study. The median pre-treatment HCV viral load (VL) was 4,560,000.

All patients continued with immunosuppression therapy adjusted according to their graft function.

DAA treatment was based on renal function, availability and hepatologist choice and evolved over time as newer agents were approved. Five patients received Sofosbuvir(SOF)+Ribavarin (RBV), 9 received SOF+Simeprevir (SIM), 26 cases received SOF+Ledipasvir(LED), 3 cases received Mavyret, 1 case each received Epclusa, Zepatier, Vieira and Daklinza. Ribavarin was used as an adjuvant agent in 50.1% cases.

Median duration from transplant to start of therapy was 19.4 months. Median Duration was 12 weeks . Mean post-treatment AST, ALT were significantly lower at end of treatment (p<0.05) with no significant change in Bilirubin, Alk Phos, or renal parameters including serum creatinine, eGFR or proteinuria. End of treatment Response was 46/47 (97.8%) of cases. SVR12 was noted in 46/47 (97.8%). There was 1 case of early discontinuation. Only 1 of the earliest cases treated with Sofosbuvir+Ribavarin was not able to achieve SVR 12 who was subsequently treated with another DAA and then achieved SVR 12. Aside from RBV induced anemia, there were no other new safety signals.

*Conclusions: We report our large series of DAA HCV treatment in kidney transplantation with excellent safety, tolerability and efficacy using multiple options of DAA with excellent success. Treatments have evolved over time and most options can be considered to be used based on availability and renal function.

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