Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan.
Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan.
Transplant Proc. 2022 Mar;54(2):549-551. doi: 10.1016/j.transproceed.2021.12.028. Epub 2022 Feb 1.
Glecaprevir/pibrentasvir is a novel anti-hepatitis C virus (HCV) drug, and it is currently the only drug available for patients with severe renal impairment. Here we report a case with renal dysfunction after an administration of glecaprevir/pibrentasvir.
The case was 66-year-old Japanese man who turned out to be HCV-positive 14 years ago at the time of his second deceased renal transplantation. He had no prior history of HCV treatment. HCV genotype was serogroup 1, and baseline HCV-RNA was 5.3 LOG IU/mL. Since glecaprevir/pibrentasvir became available, he started to take it for treatment of HCV. His immunosuppressants were tacrolimus (trough levels 4.3∼6.5 ng/mL) and 5 mg of prednisolone. His baseline renal function was serum creatinine (Cr) 2.1 mg/dL and urine protein (-). Shortly after starting glecaprevir/pibrentasvir, the serum Cr started to increase. Serum Cr reached up to 2.92 mg/dL and urine protein was (+) at day 36. Right pleural effusion was observed while cardiac function was normal. His liver function had been consistently normal. We concluded glecaprevir/pibrentasvir was the cause of renal dysfunction as no other drugs were added. Immediately after discontinuation of glecaprevir/pibrentasvir at day 36, serum Cr decreased to 1.9 mg/dL and urine protein turned negative at day 64. Although the patient completed a half course of glecaprevir/pibrentasvir, HCV-RNA turned to be negative at day 36.
We experienced a case with renal dysfunction after the initiation of glecaprevir/pibrentasvir in deceased donor renal transplant recipient. Renal dysfunction caused by glecaprevir/pibrentasvir has not been reported so far.
格卡瑞韦/哌仑他韦是一种新型抗丙型肝炎病毒（HCV）药物，是目前唯一适用于严重肾功能损害患者的药物。本文报道了一例格卡瑞韦/哌仑他韦治疗后出现肾功能障碍的病例。
该病例为 66 岁日本男性，14 年前在第二次肾移植时被诊断为 HCV 阳性。他之前没有 HCV 治疗史。HCV 基因型为 1 型，基线 HCV-RNA 为 5.3 LOG IU/mL。自从格卡瑞韦/哌仑他韦上市以来，他开始使用该药治疗 HCV。他的免疫抑制剂是他克莫司（谷浓度 4.3∼6.5ng/mL）和 5mg 泼尼松龙。他的基线肾功能为血清肌酐（Cr）2.1mg/dL，尿蛋白（-）。开始使用格卡瑞韦/哌仑他韦后不久，血清 Cr 开始升高。第 36 天，血清 Cr 升高至 2.92mg/dL，尿蛋白（+）。右侧胸腔积液，而心功能正常。他的肝功能一直正常。我们认为格卡瑞韦/哌仑他韦是导致肾功能障碍的原因，因为没有添加其他药物。第 36 天停用格卡瑞韦/哌仑他韦后，血清 Cr 降至 1.9mg/dL，第 64 天尿蛋白转为阴性。尽管该患者完成了格卡瑞韦/哌仑他韦的半程治疗，但第 36 天 HCV-RNA 转为阴性。
我们在接受肾移植的患者中观察到首例格卡瑞韦/哌仑他韦治疗后出现肾功能障碍的病例。目前尚未报道格卡瑞韦/哌仑他韦引起的肾功能障碍。
