Background

Direct-acting antiviral agents (DAAs) have improved treatment outcomes for Hepatitis C virus (HCV). Given high rates of treatment success with few side effects, eradication of chronic HCV in renal transplant recipients (RTRs) is now feasible. Limited studies suggest successful outcomes in RTRs; however, the impact of induction agents has not been evaluated. Alemtuzumab (ALM) induction in HCV positive RTRs has been postulated to adversely impact patient outcomes, though this has not been explored in the DAA era. We aimed to assess the effect of ALM on HCV treatment outcomes at a center where it is the preferred induction agent, irrespective of HCV status.

Methods

A retrospective chart review of adult RTRs who completed HCV therapy with DAAs post-transplant was conducted. Maintenance immunosuppression included tacrolimus, mycophenolate, and steroid taper per institutional protocol. Outcomes included sustained virologic response 12 weeks after therapy completion (SVR12), incidence of rejection or fibrosing cholestatic hepatitis (FCH), and graft survival.

Results

A total of 48 RTRs completed HCV treatment post-transplant. Lymphocyte-depleting induction with ALM or antithymocyte globulin was used in 73% of RTRs (LD group), while 27% received non-lymphocyte-depleting induction (non-LD group), including basiliximab or steroids alone. Baseline characteristics are included in Table 1. Ledipasvir/sofosbuvir was utilized in 77% of patients. Median time to treatment post-transplant was 1054 (IQR 287-1612) and 1481 (IQR 297-2124) days in the LD and non-LD group, respectively. SVR12 was achieved in 96.8% of the LD group versus 90% of the non-LD group; 6 patients are awaiting SVR12 results. No episodes of FCH were reported. Rejection rates were similar between groups, all prior to DAA initiation. One case of graft loss was reported after treatment.Conclusion

RTRs treated with DAAs for HCV post-transplant achieved excellent SVR rates without increasing graft loss, regardless of induction agent. ALM does not confer greater risk for HCV complications in this population.

CITATION INFORMATION: Jonchhe S, Husson J, Casale J, Adekunle R, Mathur P, Gripshover J, Ravichandran B. Impact of Alemtuzumab Induction on Hepatitis C Treatment Outcomes Post-Renal Transplantation. Am J Transplant. 2017;17 (suppl 3).

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