Assessment of Renal Function in Post-Liver Transplant HCV-Positive Patients Treated with Direct Acting Antivirals

Abstract

Khaled Elzorkany,1,2 Mahmoud Abd-Elaziz Kora,1 Aliaa Sabry Abdel Wahed,3 Hassan El-Sayed Zaghla,3 Ahmed Mohamed Zahran,1 Yassein Salah Yassein,1 Asmaa Zaki El Naggar,4 Abdallah Essa,5 Abdelnaser Abdelaty Gadallah1 1Internal Medicine Department, Faculty of Medicine, Menoufia University, Shibin El-Kom, Egypt; 2Internal Medicine Department, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia; 3Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shibin El- Kom, Egypt; 4Menshawy Hospital, Tanta, Egypt; 5Tropical Medicine Department, Faculty of Medicine, Menoufia University, Shibin El-Kom, EgyptCorrespondence: Khaled ElzorkanyInternal Medicine Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, EgyptTel 00201002827630Email [email protected]: Direct acting antiviral agents (DAAs) have greatly improved the clearance of hepatitis C virus (HCV) infection. The effect of DAAs on renal function in post-liver transplant HCV-positive patients remains questionable, especially considering the possibility of drug interactions between immunosuppressants and DAAs.Patients and methods: A retrospective observational study included 84 post-liver transplant patients with HCV infection. Patients were divided into two groups: group I received sofosbuvir plus ribavirin for 24 weeks, group II received sofosbuvir plus daclatasvir for 12 weeks. Laboratory data and eGFR were determined before, at the end, and 6 months after completion of treatment.Results: The treatment was well tolerated with 100% sustained virologic response (SVR 12). There was no statistically significant difference between the two groups regarding clinical and laboratory data before treatment. Mean eGFR significantly reduced from 87.36 mL/min to 76.16 mL/min in group I (P=0.001). However, within 6 months after treatment, mean eGFR recovered to 81.51 mL/min, which was not significant when compared to baseline eGFR (P=0.09). Mean eGFR in group II showed non-significant change. There were no significant changes in immunosuppressive drug levels and eGFR in either group of patients, who received either ciclosporin or tacrolimus before and at the end of treatment.Conclusion: DDAs in post-liver transplant patients with HCV infection were well tolerated and associated with stable renal function. Moreover, sofosbuvir plus daclatasvir regimen showed relatively better renal safety compared to sofosbuvir plus ribavirin.Keywords: renal function, hepatic transplantation, direct acting antiviral agents, hepatitis C treatment

Keywords

• renal function
• hepatic transplantation
• direct acting antiviral agents and hepatitis c treatment.