Prasad N, Patel M R, Pandey A, Jaiswal A, Bhadauria D, Kaul A, Sharma R K, Mohindra S, Pandey G, Goel A, Gupta A
Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Indian J Nephrol. 2018 May-Jun;28(3):220-225. doi: 10.4103/ijn.IJN_190_17.
Hepatitis C virus (HCV) infection in renal allograft recipient is associated with increased morbidity and mortality. At present, only few studies related to treatment and outcomes of HCV-infected renal allograft recipients with DAAs have been published. We aimed the study to assess the efficacy and safety of sofosbuvir-based regimens in HCV-infected renal allograft recipients. We analyzed data of 22 eligible HCV-infected renal allograft recipients (14 genotype-3, 6 genotype-1, one each genotype-2 and 4) who were treated with DAAs at our institute. DAA regimen included sofosbuvir and ribavirin with or without ledipasvir or daclatasvir for 12-24 weeks. Patients were followed up for 24 weeks after completion of treatment. A rapid viral response of 91%, end of therapy response of 100%, and sustained viral response at 12 and 24 weeks of 100% with rapid normalization of liver enzymes were observed. Therapy was well tolerated except for ribavirin-related anemia. A significant decrease in tacrolimus trough levels was observed and most patients required increase in tacrolimus dose during the study. Treatment with newer DAAs is effective and safe for the treatment of HCV-infected renal allograft recipients.
肾移植受者丙型肝炎病毒（HCV）感染与发病率和死亡率增加相关。目前，仅有少数关于使用直接抗病毒药物（DAAs）治疗HCV感染的肾移植受者及其预后的研究发表。我们开展这项研究旨在评估基于索磷布韦的治疗方案对HCV感染的肾移植受者的疗效和安全性。我们分析了在我院接受DAAs治疗的22例符合条件的HCV感染肾移植受者的数据（14例基因3型、6例基因1型、基因2型和4型各1例）。DAA治疗方案包括索磷布韦和利巴韦林，联合或不联合来迪派韦或达拉他韦，疗程为12 - 24周。治疗结束后对患者进行了24周的随访。观察到快速病毒学应答率为91%，治疗结束时应答率为100%，在12周和24周时持续病毒学应答率为100%，且肝酶迅速恢复正常。除了与利巴韦林相关的贫血外，治疗耐受性良好。观察到他克莫司谷浓度显著下降，且大多数患者在研究期间需要增加他克莫司剂量。使用新型DAAs治疗HCV感染的肾移植受者是有效且安全的。
