The American Transplant Congress (ATC) is the joint annual meeting of the American Society of Transplant Surgeons and the American Society of Transplantation. This year the conference is being held in Boston, MA. Stay tuned for highlights from the conference.
Ledipasvir/Sofosbuvir for Hepatitis C Virus–Infected Kidney Transplant Recipients
Direct acting antiviral (DAA) agents are revolutionizing the treatment of hepatitis C. Hepatitis C has a high prevalence in dialysis patients, and therefore affects many kidney transplant recipients. Compared to non-infected patients, those infected with hepatitis C virus (HCV) have worse kidney graft survival, more proteinuria, and more cardiovascular disease Treating these patients has the potential to improve their long-term outcome. Although clinicians have already begun treating such patients, there is limited data on the use of DDA agents in patients with kidney transplants.
During a plenary session, Dr. Pol described the results of a large multicenter European study comparing 12- and 24-week treatment with Ledipasvir/Sofosbuvir in HCV-infected kidney transplant recipients. The investigators enrolled 113 patients from 5 sites across Europe that were infected with HCV genotype 1 or 4. To qualify for enrollment, patients had to have a glomerular filtration rate (GFR) greater than 40 mL/min/1.73 m2 and be more than 6 months post transplant. The primary endpoint was sustained viral response at 12 weeks. One third of the patients had previously been treated with interferon, and 15% had cirrhosis. The results are impressive. All patients in both groups had negative viral loads at 12 weeks. There were no rejection episodes, although 4 patients experienced a drop in GFR during treatment. Adverse events were minimal. Data regarding immunosuppression levels and proteinuria were not presented.
This study suggest that both 12 and 24 weeks of Ledipasvir/Sofosbuvir are both efficacious and well tolerated in HCV-infected kidney transplant recipients. This not only has the potential of improving outcomes in HCV-infected kidney transplant recipients but also may open doors to expanded use of HCV-positive donor kidneys for HCV-positive individuals–and dare I say–perhaps even HCV-negative individuals.
Post by Dr. Vinay Nair, AJKD Blog Advisory Board member.