Background: Hepatitis C virus infection (HCV) has historically portended a poor outcome after kidney transplantation. With recent advent of direct antiviral agents (DAA), there has been a high rate of successful HCV eradication after transplantation. However, data on immunologic injury to the graft with therapy are lacking.

Methods: We studied 20 HCV+ kidney transplant patients (KT) who underwent DAA treatment with median F/U of 26 mos (range 11-117). We collected data on demographics, DAA regimen, CNI levels, graft function, donor specific antibodies (DSA) & surveillance &/or for cause graft biopsies (bx) findings.

Results: Mean age±SD was 61.9±6.1yo, (18M/2F), 75% non-Caucasian, all were infected with genotype 1, DAA regimen was Harvoni (n=19), sofosbuvir/simeprevir (n=1). There was no statistical significant difference between the mean serum creatinine (Cr) & proteinuria (P/Cr ratio) pre DAA treatment & at the last F/U (Cr 1.39 vs 1.42 mg/dl, p=0.58, P/Cr 0.74vs 0.91, p=0.64). 5 KT had bx proven rejection post DAA.

Mean time from DAA start to last F/U was 21.7 ±10.1mo. 4/5 had Antibody mediated rejections (AMR). Mean Tacrolimus levels (n=18) during DAA was statistically significant lower in week 12 of DAA treatment than 2 weeks prior to DAA start (-3.22, p=0.0042).

Conclusion: There is a significant decline in mean CNI levels during DAA therapy in KT.Despite relatively stable graft function, there is a significant incidence of clinical & subclinical rejections 5/20 (25%) especially AMR 4/5 (80%) detected by protocol & for-cause bx.The study highlights the need for close monitoring of immunosuppression & surveillance during DAA administration in KT.

CITATION INFORMATION: Zaky Z., Armanyous S., Herlitz L., Poggio E., Augustine J. Impact of Direct Antiviral Therapy for Hepatitis C on Acute Rejection and DSA Formation in Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress