Impact 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 |
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| Authors: | Mario Fernández‐Ruiz Natalia Polanco Ana García‐Santiago Raquel Muñoz Ana M. Hernández Esther González Verónica R. Mercado Inmaculada Fernández José María Aguado Manuel Praga Amado Andrés |
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| Affiliation: | 1. Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (i + 12), School of Medicine, Universidad Complutense, Madrid, Spain;2. Department of Nephrology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (i + 12), School of Medicine, Universidad Complutense, Madrid, Spain;3. Department of Gastroenterology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (i + 12), School of Medicine, Universidad Complutense, Madrid, Spain |
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| Abstract: | 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 (ΔeGFR ) 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 ΔeGFR 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. |
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| Keywords: | direct antiviral agents hepatitis C virus kidney transplantation medium‐term graft function therapeutic drug monitoring |
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