Rendina Maria, Paoletti Ernesto, Labarile Nunzia, Marra Antonella, Iannone Andrea, Castellaneta Antonino, Bussalino Elisabetta, Ravera Maura, Schena Antonio, Castellaneta Nicola M, Barone Michele, Simone Simona, Gesualdo Loreto, Di Leo Alfredo
Gastroenterology and Digestive Endoscopy, University Hospital, Bari, Italy.
Nephrology, Dialysis, and Transplantation, University of Genova and Policlinico San Martino, Genova, Italy.
Ther Adv Chronic Dis. 2022 Sep 17;13:20406223221117975. doi: 10.1177/20406223221117975. eCollection 2022.
BACKGROUND/AIM: Direct-acting antivirals (DAAs) have improved the treatment of HCV-positive kidney transplant recipients (KTRs). However, their medium-term follow-up effects on graft function are conflicting. This study aimed to analyze how the interplay between DAAs, calcineurin inhibitors (CNI), and HCV eradication impacts 12-month kidney graft function.
This double-center retrospective study with a prospective follow-up enrolled 35 KTRs with HCV treated with DAAs for 12 weeks. We compared three parameters: estimated glomerular filtration rate (eGFR), 24-h proteinuria, and CNI trough levels at three time points: baseline, end of treatment (EOT), and 12 months later.
Kidney allograft function remained stable when comparing baseline and 12-month post-treatment values of eGFR (60.7 57.8 ml/min; = 0.28) and 24-h proteinuria (0.3 0.2 g/24 h; = 0.15), while tacrolimus (Tac) trough levels underwent a statistically significant decline (6.9 5.4 ng/ml; = 0.004). Using an ongoing triple Tac-based maintenance therapy as a conservative measure, a dose escalation of Tac was applied only in seven patients. No variation in CyA and mTOR levels was detected.
DAA therapy is safe and effective in HCV-positive KTRs. It also produces a persistent significant reduction in Tac trough levels that does not influence graft function at 12 months.
背景/目的：直接抗病毒药物（DAA）改善了丙型肝炎病毒阳性肾移植受者（KTR）的治疗。然而，它们对移植肾功能的中期随访效果存在矛盾。本研究旨在分析DAA、钙调神经磷酸酶抑制剂（CNI）和丙型肝炎病毒根除之间的相互作用如何影响12个月时的肾移植功能。
这项双中心回顾性研究并进行前瞻性随访，纳入了35例接受DAA治疗12周的丙型肝炎病毒阳性KTR。我们比较了三个参数：估计肾小球滤过率（eGFR）、24小时蛋白尿以及在三个时间点的CNI谷浓度：基线、治疗结束时（EOT）和12个月后。
比较eGFR的基线值和治疗后12个月的值（60.7对57.8ml/分钟；P = 0.28）以及24小时蛋白尿（0.3对0.2g/24小时；P = 0.15）时，同种异体肾移植功能保持稳定，而他克莫司（Tac）谷浓度有统计学意义的下降（6.9对5.4ng/ml；P = 0.004）。作为一种保守措施，使用持续的基于Tac的三联维持治疗，仅7例患者增加了Tac剂量。未检测到环孢素A（CyA）和雷帕霉素靶蛋白（mTOR）水平的变化。
DAA治疗对丙型肝炎病毒阳性KTR是安全有效的。它还使Tac谷浓度持续显著降低，且在12个月时不影响移植肾功能。
