Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
Weill Cornell Medical College in Qatar, Doha, Qatar.
Immun Inflamm Dis. 2021 Mar;9(1):246-254. doi: 10.1002/iid3.386. Epub 2020 Dec 2.
Hepatitis C virus (HCV) infection has detrimental effects on patient and graft survival after kidney transplantation. In the pre-direct-acting antiviral (DAA) era, treatment of HCV infection was associated with low response rates, poor tolerance, and increased risk of allograft rejection. However, DAAs have revolutionized HCV treatment. The aims of this study were to determine the impact of DAA on the sustained virologic response (SVR), renal function, and calcineurin inhibitor (CNI) levels and assess the tolerability to treatment in kidney transplant recipients with HCV infection in Qatar.
This retrospective study included the medical records of all kidney transplant recipients with confirmed HCV infection before January 1, 2020. All data were obtained from the patients' electronic medical records; these included patient demographics; virologic responses to treatment; serum creatinine levels during treatment; urine protein to creatinine ratios and CNI levels before, during, and after treatment; and side effects related to DAA therapy.
A total of 27 kidney transplant recipients with HCV were identified, 23 of whom received DAA therapy. The length of treatment ranged from 12 to 24 weeks, and 52% of patients had HCV genotype 1 infection. The median log10 HCV RNA was 6.6 copies per milliliter. None of the patients had liver cirrhosis, and all of them achieved SVR. There was no statistically significant difference in the glomerular filtration rate before, during, and after treatment. Most patients had stable CNI trough levels during treatment and did not require dose adjustment.
HCV infection was successfully eradicated by DAA therapy in kidney transplant recipients, with a 100% SVR rate. Moreover, DAA therapy was well-tolerated, and kidney function remained stable without an increased risk of rejection. These results are expected to drive the eradication of hepatitis C from the entire country.
丙型肝炎病毒 (HCV) 感染会对肾移植后患者和移植物的存活产生不利影响。在直接作用抗病毒药物 (DAA) 问世之前，HCV 感染的治疗反应率低、耐受性差，且增加移植物排斥的风险。然而，DAA 彻底改变了 HCV 的治疗方式。本研究的目的是确定 DAA 对持续病毒学应答 (SVR)、肾功能和钙调磷酸酶抑制剂 (CNI) 水平的影响，并评估 HCV 感染的肾移植受者对治疗的耐受性。
本回顾性研究纳入了 2020 年 1 月 1 日前确诊 HCV 感染的所有肾移植受者的病历。所有数据均来自患者的电子病历，包括患者的人口统计学特征；治疗期间的病毒学应答；治疗期间的血清肌酐水平；治疗前后的尿蛋白与肌酐比值和 CNI 水平；以及与 DAA 治疗相关的副作用。
共确定了 27 例 HCV 感染的肾移植受者，其中 23 例接受了 DAA 治疗。治疗时间为 12-24 周，52%的患者感染 HCV 基因型 1。中位 log10 HCV RNA 为 6.6 拷贝/毫升。无患者患有肝硬化，所有患者均达到 SVR。治疗前后肾小球滤过率无统计学差异。大多数患者在治疗期间 CNI 谷值水平稳定，无需调整剂量。
DAA 治疗成功清除了肾移植受者的 HCV 感染，SVR 率为 100%。此外，DAA 治疗耐受性良好，肾功能保持稳定，无排斥反应风险增加。这些结果有望推动整个国家消灭丙型肝炎。
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