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Balk EM, Adam GP, Jadoul M, Martin P, Gordon CE. A Systematic Review of Direct-Acting Antivirals for Hepatitis C in Advanced CKD. Kidney Int Rep 2022; 8:240-253. [PMID: 36815114 PMCID: PMC9939364 DOI: 10.1016/j.ekir.2022.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Direct-acting antivirals (DAAs) have improved treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD). To facilitate the 2022 update of the Kidney Disease: Improving Global Outcomes (KDIGO) guideline for CKD patients with HCV, we systematically reviewed DAA regimens in patients with CKD stages G4 and G5 nondialysis (G4-G5ND), CKD stage G5 on dialysis (G5D), and kidney transplant recipients (KTRs). Methods We conducted a systematic review by searching PubMed, Embase, Cochrane, CINAHL, and ClinicalTrials.gov through February 1, 2022, and conferences from 2019 to 2021. Studies of HCV-infected patients with CKD G4-G5ND, G5D, and KTRs treated with specified DAA regimens were included. Outcomes included death at 6 months or later, sustained virologic response at 12 weeks (SVR12), serious adverse events (SAEs) attributed to DAA, and treatment discontinuation because of adverse events. Maximum likelihood meta-analyses were determined; certainty of evidence was assessed per GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Results We identified 106 eligible studies (22 reported on CKD G4-G5ND, 69 on CKD G5D, and 29 on KTRs). In each population, the majority of DAA regimens achieved SVR12 ≥ 93%. We found generally low quality of evidence of low risk of SAEs (mostly 0%, up to 2.9%) and low risk of discontinuation because of adverse events (mostly 0%-5%). Across 3 unadjusted observational studies in KTRs, the risk of death after DAA treatment was substantially lower than without treatment (summary odds ratio, 0.16; 95% CI, 0.04-0.61). Conclusion Combination DAA regimens are safe and highly effective in patients with advanced CKD, on dialysis, and with kidney transplants.
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Affiliation(s)
- Ethan M. Balk
- Brown Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Gaelen P. Adam
- Brown Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Michel Jadoul
- Department of Nephrology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Paul Martin
- Division of Digestive Health and Liver Diseases, University of Miami School of Medicine, Miami, Florida, USA
| | - Craig E. Gordon
- Division of Nephrology, Department of Medicine, Tufts University School of Medicine, Boston, Massachussetts, USA,Correspondence: Craig E. Gordon, Division of Nephrology, Department of Medicine, Tufts University School of Medicine, 800 Washington Street, Box 391, Boston, Massachussetts 02111, USA.
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Chevallier E, Büchler M, Caillard S, Bouvier N, Colosio C, Rivalan J, Sayegh J, Bertrand D, Le Meur Y, Thierry A, Garrouste C, Rerolle JP, Rostaing L, Gatault P. Chronic Hepatitis C Virus Infection After Kidney Transplantation With or Without Direct-Acting Antivirals in a Real-Life Setting: A French Multicenter Experience. Transplant Proc 2020; 52:3179-3185. [PMID: 32636068 DOI: 10.1016/j.transproceed.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/04/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Kidney transplant recipients (KTRs) are frequently infected with chronic hepatitis C virus (HCV), which can increase the risk of graft loss. Active HCV infections among KTRs are associated with shorter survival times. The emergence of very efficient interferon-free treatments (direct-acting antivirals [DAAs]) has revolutionized prognoses for chronic viral hepatitis. We performed a multicenter study where HCV (+)/RNA (+) KTRs were followed up and either received DAAs (group A) or not (group B) according to the transplant center. The aim was to assess, in a real-life setting, the impact of DAA therapy and to compare these results with those from HCV RNA (+) KTRs where HCV infection was not treated during the same period. METHODS This study included 66 patients from 11 centers: 44 patients (66.7%; group A) received DAAs, whereas 22 patients did not (group B); the 2 groups were comparable according to baseline data. Most patients (88.6%) received sofosbuvir, 50% received ledipasvir, and 34.7% received daclatasvir. The duration of treatments ranged from 8 to 24 weeks. RESULTS HCV RNA clearance (ie, a sustained virologic response) was observed in 95.4% of treated patients. Eradication of HCV led to a significant decrease in liver enzymes (50% reduction for alanine aminotransferase [P ≤ .001] and 41% for gamma glutamyl transpeptidase [P < .001]). Conversely, liver enzymes did not decrease in group B. Death occurred significantly more frequently in nontreated than treated patients (3 in group B vs none in group A, P = .003). Of the 10 treated patients with severe renal impairment before DAA therapy, 6 experienced graft loss. CONCLUSION DAAs are very effective at treating chronic HCV and have an excellent tolerance profile.
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Affiliation(s)
- Eloi Chevallier
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, CHU Grenoble-Alpes, Grenoble, France; Grenoble-Alpes University, Grenoble, France
| | - Matthias Büchler
- Department of Nephrology and Clinical Immunology, CHU Tours, Tours, France
| | - Sophie Caillard
- Department of Nephrology, Strasbourg University Hospital, Strasbourg, France
| | - Nicolas Bouvier
- Department of Nephrology, Caen University Hospital, Caen, France
| | | | - Joseph Rivalan
- Department of Nephrology, Rennes University Hospital, Rennes, France
| | - Johnny Sayegh
- Department of Nephrology, Angers University Hospital, Angers, France
| | | | - Yannick Le Meur
- Department of Nephrology, Brest University Hospital, Brest, France
| | - Antoine Thierry
- Department of Nephrology, Poitiers University Hospital, Poitiers, France
| | - Cyril Garrouste
- Department of Nephrology, Clermont Ferrand University Hospital, Clermont Ferrand, France
| | | | - Lionel Rostaing
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, CHU Grenoble-Alpes, Grenoble, France; Grenoble-Alpes University, Grenoble, France.
| | - Philippe Gatault
- Department of Nephrology and Clinical Immunology, CHU Tours, Tours, France
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Darema M, Cholongitas E, Filiopoulos V, Marinaki S, Pavlopoulou ID, Tsoubou I, Boletis JN, Papatheodoridis GV. Efficacy and safety of new direct-acting antivirals in kidney transplant recipients with chronic hepatitis C: a single-center study. Ann Gastroenterol 2020; 33:285-292. [PMID: 32382232 PMCID: PMC7196623 DOI: 10.20524/aog.2020.0481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/03/2020] [Indexed: 12/14/2022] Open
Abstract
Background The recent interferon-free direct-acting antiviral (DAA) regimens have very good safety and efficacy profiles and are highly recommended for kidney transplant (KT) recipients with chronic hepatitis C (CHC). Methods All KT recipients with CHC followed at our hospital and who received therapy with the current DAAs were included. At the baseline visit, demographic, clinical and laboratory variables before and after KT, as well as at the commencement of DAAs, at the end of antiviral therapy and the end of follow up, were recorded, including assessment of glomerular filtration rate (eGFR). The changes in eGFR (DGFR) between baseline and end of therapy (1st period), and between end of therapy and end of follow up (2nd period), were evaluated. Results Twelve KT recipients were retrospectively evaluated: 2 had received antiviral therapy in the past; 4 (33.3%) patients had genotype 1 and 3 (25%) genotype 4 CHC. The median stiffness was 11.9 kPa (range 5-16.8), while 5 patients, none with decompensated cirrhosis, had stiffness >12.5 kPa. Eight patients received a sofosbuvir-containing antiviral regimen (Group 1) and 4 patients received an antiviral regimen without sofosbuvir (Group 2). Eleven (91.7%) patients achieved a sustained virological response (SVR). One patient discontinued DAAs early after treatment and did not achieve SVR. Otherwise, DAAs were well tolerated and no rejection episode was recorded. The DGFRs in the 1st period and 2nd period did not differ significantly between Group 1 and Group 2 patients. Conclusion In this real-world study of KT recipients with CHC, the high efficacy and clinically acceptable tolerability of DAAs were confirmed.
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Affiliation(s)
- Maria Darema
- Nephrology Department and Transplantation Unit, Laiko Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Medical School of National and Kapodistrian University, Athens, Greece
| | - Vassilis Filiopoulos
- Nephrology Department and Transplantation Unit, Laiko Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Smaragdi Marinaki
- Nephrology Department and Transplantation Unit, Laiko Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna D Pavlopoulou
- National and Kapodistrian University of Athens, Faculty of Nursing P. & A. Kyriakou Children's Hospital
| | - Ioanna Tsoubou
- Nephrology Department and Transplantation Unit, Laiko Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John N Boletis
- Nephrology Department and Transplantation Unit, Laiko Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George V Papatheodoridis
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Athens, Greece
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Calça R, Jorge C, Lebre L, Cacheira E, Querido S, Nascimento C, Adragão T, Bruges M, Weigert A, Machado D. Hepatocellular carcinoma after direct-acting antiviral therapy in kidney transplant recipients infected with hepatitis C virus. Nefrologia 2020; 40:675-676. [PMID: 31937466 DOI: 10.1016/j.nefro.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Rita Calça
- Department of Nephrology, Hospital Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
| | - Cristina Jorge
- Department of Nephrology, Hospital Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Luís Lebre
- Department of Gastroenterology, Hospital Egas Moniz - Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Eunice Cacheira
- Department of Nephrology, Hospital Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Sara Querido
- Department of Nephrology, Hospital Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Célia Nascimento
- Department of Nephrology, Hospital Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Teresa Adragão
- Department of Nephrology, Hospital Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Margarida Bruges
- Department of Nephrology, Hospital Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - André Weigert
- Department of Nephrology, Hospital Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Domingos Machado
- Department of Nephrology, Hospital Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
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Maghrabi HME, Elmowafy AY, Refaie AF, Elbasiony MA, Shiha GE, Rostaing L, Bakr MA. Efficacy and safety of the new antiviral agents for the treatment of hepatitis C virus infection in Egyptian renal transplant recipients. Int Urol Nephrol 2019; 51:2295-2304. [PMID: 31531807 DOI: 10.1007/s11255-019-02272-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/28/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Hepatitis C virus (HCV) infection in kidney transplant recipients (KTRs) is common and can impact on patient and graft survival rates. The efficacy and safety of direct-acting antivirals (DAAs) to treat genotype-4 HCV-infected KTRs have not been fully established. METHODS A prospective, single-arm, single-center study was conducted at Mansoura Urology/Nephrology Center (Mansoura University, Egypt). 114 HCV RNA(+) genotype 4 KTRs were enrolled in this study after a hepatology consultation and consented to start treatment with interferon-free DAAs. A sofosbuvir-based regimen was given to 109 recipients that had creatinine clearance (Crcl) of > 30 mL/min/1.73 m2. Ritonavir-boosted paritaprevir/ombitasvir was prescribed to five recipients with Crcl < 30 mL/min/1.73 m2. RESULTS The mean age of the cohort was 45.2 ± 11.2 years; most were male. The mean duration with a transplant was 14.2 ± 3.5 years, with different immunosuppressive regimens, mostly based on calcineurin inhibitors. A rapid virological response (RVR), i.e., clearance of viral load, was achieved in 100% at 4 weeks after starting treatment. All patients had a sustained virological response (SVR) at 12 and 24 weeks posttreatment, with one exception. During DAA therapy serum creatinine increased in 12 patients. In three, this was concomitant with elevated calcineurin inhibitor and sirolimus trough levels. Graft biopsies were performed in 8 of these 12 patients: these revealed an acute rejection in 4 cases (acute cellular rejection grade-1A: n = 2, and grade-1B: n = 2). The rejection episodes occurred at 4-6 weeks after starting treatment. CONCLUSION DAAs were highly efficacious and safely treated genotype-4 HCV-infected KTRs and had no significant adverse effects on graft function/survival.
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Affiliation(s)
- Hanzada Mohamed El Maghrabi
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.,Nephrology Department, Port-Said University, Port Said, Egypt
| | | | | | - Mohammed Adel Elbasiony
- Egyptian Liver research Institute and Hospital, Mansoura, Egypt.,Internal Medicine Department, Mansoura University, Mansoura, Egypt
| | | | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, CS 10217, 38043, Grenoble Cedex 09, France.
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Kawagishi N, Nakamura A, Takayama T, Haga I. Safety of Direct-Acting Antiviral Therapy for Renal Function in Post-Kidney Transplant Patients Infected with Hepatitis C Virus and a 100% 12-Week Sustained Virologic Response: A Single-Center Study. Ther Apher Dial 2019; 24:184-188. [PMID: 31290282 DOI: 10.1111/1744-9987.13350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 12/13/2022]
Abstract
Treatment of chronic hepatitis C infection after renal transplantation has been controversial due to the high rate of graft rejections with interferon (IFN)-based therapies. The aim of this study is to review our experience of direct acting antiviral therapy for the recipients of renal transplantation. Eleven recipients who were hepatitis C virus-polymerase chain reaction (PCR) positive were eligible for the treatment with direct acting antivirals. Six recipients were treated with sofosbuvir and ledipasvir, three were treated with elbasvir and grazoprevir, and one was treated with sofosbuvir and ribavirin for 12 weeks. One recipient was treated with glecaprevir and pibrentasvir for 8 weeks. All of the 11 recipients exhibited sustained virologic response at week 12 after the end of treatment. Adverse events were scarce including the two recipients who switched to tacrolimus from cyclosporine at the beginning of the treatment. The direct acting antiviral therapy including new agents appears to be safe and highly efficacious for the recipients after renal transplantation.
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Affiliation(s)
- Naoki Kawagishi
- Division of Transplant Surgery, JCHO Sendai Hospital, Sendai, Japan
| | - Atsushi Nakamura
- Division of Transplant Surgery, JCHO Sendai Hospital, Sendai, Japan
| | - Tetsuro Takayama
- Division of Transplant Surgery, JCHO Sendai Hospital, Sendai, Japan
| | - Izumi Haga
- Division of Transplant Surgery, JCHO Sendai Hospital, Sendai, Japan
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