Treatment of hepatitis C with direct-acting antiviral agents in renal transplant recipients: a long-term and real-world experience

Purpose: Direct- acting antivirals (DAAs) are showing encouraging results in hepatitis C virus (HCV) eradication and drug safety, but limited data exist for renal transplant recipients (RTRs). In addition, data are lacking regarding the outcomes of RTRs who failed a previous DAA regimen. Method: We collected data from 17 consecutive HCV-infected RTRs treated with DDAs to evaluate DAA efficacy, relevant side effects, and long-term patient outcomes. Initial DAA regimens included sofosbuvir (SOF)-based regimens in 16 patients (94%) and daclatasvir plus asunaprevir in 1 patient. Results: All patients exhibited a rapid virologic response to therapy and 14 patients (82.3%) achieved a sustained virologic response at 12 weeks after the end of therapy. The anti-HCV regimens were well tolerated, but the tacrolimus level decreased significantly at 2 weeks after treatment. Two RTRs with prior DAA failure were successfully retreated with SOF plus velpatasvir (VEL). Conclusions: IFN-free DAAs were efficacious and well-tolerated in our Asian RTRs. Patients should be carefully monitored to avoid sub-therapeutic immunosuppression in routine practice, regardless of DAA regimens. This is a first report that the combination of SOF and VEL is apparently effective and well-tolerated in RTRs with prior DAAs failure. Further studies are needed to verify our findings.