Treatment of Hepatitis C Virus in Kidney Transplant Recipients With Direct Acting Anti-Viral Agents: Early Results in 12 Cases

A. Sharfuddin,¹ T. Taber,¹ M. Mujtaba,¹ M. Yaqub,¹ D. Mishler,¹ P. Kwo,² R. Vuppalanchi.²

¹Medicine/Nephrology, Indiana University, Indianapolis
²Medicine/Hepatology, Indiana University, Indianapolis.

Meeting: 2015 American Transplant Congress

Abstract number: 521

Keywords: Efficacy, Hepatitis C, Kidney transplantation

Session Information

Session Name: Concurrent Session: Late Breaking

Session Type: Concurrent Session

Date: Tuesday, May 5, 2015

Session Time: 2:15pm-3:45pm

Presentation Time: 3:15pm-3:27pm

Location: Terrace IV

Background: Recently approved direct acting antiviral agents (DAA) for treatment of HCV are interferon sparing allowing an attractive treatment option for kidney transplant recipient with HCV. The efficacy and safety of DAAs is however currently unknown as studies are lacking.

Results: Kidney recipients were referred for treatment as indicated by their liver or kidney graft or liver graft function. Of the 12 patients on treatment, 8 were males, 7 were African-American, 3 cases of combined liver-kidney transplant, mean age of 55.8+/-8.5 years. 8 patients were naive to any anti-HCV therapy, while 11 cases were of genotype 1a. The mean pre-treatment HCV viral load (VL) was 25.6 million+/-38.0 IU/ml. All patients continued with immunosuppression therapy adjusted according to their graft function. Four patients received Sofosbuvir(SOF)+Ribavarin (RBV), 6 received SOF+Simeprevir (SPV), and 1 each SOF+SPV+RBV and SOF+Ledipasvir. Mean duration from transplant to start of therapy was 48.9+/-51.5 months (range 2.6-139). Intended duration was 12weeks in 7 cases and 24 in 5 cases.

Mean pre-treatment AST/ALT/Alk Phos were 94+/-70, 76+/-65, 190+/-149 respectively. Mean pre-treatment Serum Cr, proteinuria and tacrolimus levels were 1.9+/-0.6, 2.2+/-2.2 and 5.8+/-2.0 respectively. Mean post-treatment AST, ALT were significantly lower at 22+/-13 and 16+/-10 (p<0.05) with no significant change in other liver or renal parameters, although there was a trend towards lower proteinuria at 1.7+/-1.9 g/day.

During treatment week 4 VL was available in 11 cases and was undetectable in 72% (<15 IU/ml). End of treatment VL was available in 11 cases and was undetectable in 10/11(90.9%) of cases. Sustained Viral Response at 4 weeks (SVR4) was available in 9 cases and was undetectable in 8/9 cases (88.8%). SVR12 was undetectable in 2/3 cases so far and we will have SVR12 in all cases to report. There has been only 1 case of recurrence of HCV, while 1 case had to discontinue treatment early due to ongoing deterioration in renal function secondary to infections and chronic rejection. All RBV cases experienced Anemia. There were no other safety adverse effects related to the new DAA therapy.

Conclusion: We report to date the largest series of DAA HCV treatment in kidney transplantation with excellent safety, tolerability and early success.

To cite this abstract in AMA style:

Sharfuddin A, Taber T, Mujtaba M, Yaqub M, Mishler D, Kwo P, Vuppalanchi R. Treatment of Hepatitis C Virus in Kidney Transplant Recipients With Direct Acting Anti-Viral Agents: Early Results in 12 Cases [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/treatment-of-hepatitis-c-virus-in-kidney-transplant-recipients-with-direct-acting-anti-viral-agents-early-results-in-12-cases/. Accessed May 12, 2025.

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