Open AccessImpact of anti‐HCV direct antiviral agents on graft function and immunosuppressive drug levels in kidney transplant recipients: a call to attention in the mid‐term follow‐up in a single‐center cohort study
Author(s) -
FernándezRuiz Mario,
Polanco Natalia,
GarcíaSantiago Ana,
Muñoz Raquel,
Hernández Ana M.,
González Esther,
Mercado Verónica R.,
Fernández Inmaculada,
Aguado José María,
Praga Manuel,
Andrés Amado
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13118
Subject(s) - medicine , tacrolimus , renal function , immunosuppression , sofosbuvir , proteinuria , gastroenterology , hepatitis c virus , everolimus , urology , single center , hepatitis c , ledipasvir , kidney , immunology , transplantation , virus , ribavirin
Summary The medium‐term impact on graft function and immunosuppressive drug pharmacokinetics of direct antiviral agents ( DAA s) among hepatitis C virus ( HCV )‐infected kidney transplant ( KT ) recipients remain unclear. We compared pre‐ and post‐treatment 12‐month trajectories of estimated glomerular filtration rate (Δe GFR ) and 24‐h proteinuria (Δ24‐h proteinuria) in 49 recipients treated with DAA s (mostly sofosbuvir plus ledipasvir). Among evaluable patients, 66.7% and 100.0% had undetectable viral load by week 4 and end of therapy (EoT). The sustained virologic response rate at 12 weeks was 95.8%. Overall, 80.6% of patients receiving tacrolimus required dose escalation while on DAA ‐based therapy (median increase of 66.7%) to maintain target levels. Tacrolimus levels resulted to be higher at 12 months compared to EoT (7.8 ± 2.1 vs. 6.7 ± 2.0 ng/ ml ; P ‐value = 0.002). No changes in graft function during the course of therapy were observed. However, eGFR significantly decreased ( P ‐value <0.001) throughout the first 12 months after EoT. Median Δe GFR and Δ24‐h over pre‐ and post‐treatment periods were 3.9% and −6.1% ( P ‐value = 0.002) and −5.3% and 26.2% ( P ‐value = 0.057). Caution should be exercised when adjusting immunosuppression in HCV ‐infected KT recipients upon initiation of DAA s, followed by mid‐term monitoring of immunosuppressive drug levels and graft function.