Impact of anti-HCV direct antiviral agents on graft function and immunosuppressive drug levels in kidney transplant recipients : a call to attention in the mid-term follow-up in a single-center cohort study
© 2018 Steunstichting ESOT..
The medium-term impact on graft function and immunosuppressive drug pharmacokinetics of direct antiviral agents (DAAs) among hepatitis C virus (HCV)-infected kidney transplant (KT) recipients remain unclear. We compared pre- and post-treatment 12-month trajectories of estimated glomerular filtration rate (ΔeGFR) and 24-h proteinuria (Δ24-h proteinuria) in 49 recipients treated with DAAs (mostly sofosbuvir plus ledipasvir). Among evaluable patients, 66.7% and 100.0% had undetectable viral load by week 4 and end of therapy (EoT). The sustained virologic response rate at 12 weeks was 95.8%. Overall, 80.6% of patients receiving tacrolimus required dose escalation while on DAA-based therapy (median increase of 66.7%) to maintain target levels. Tacrolimus levels resulted to be higher at 12 months compared to EoT (7.8 ± 2.1 vs. 6.7 ± 2.0 ng/ml; P-value = 0.002). No changes in graft function during the course of therapy were observed. However, eGFR significantly decreased (P-value <0.001) throughout the first 12 months after EoT. Median ΔeGFR and Δ24-h over pre- and post-treatment periods were 3.9% and -6.1% (P-value = 0.002) and -5.3% and 26.2% (P-value = 0.057). Caution should be exercised when adjusting immunosuppression in HCV-infected KT recipients upon initiation of DAAs, followed by mid-term monitoring of immunosuppressive drug levels and graft function.
| Errataetall: |
CommentIn: Transpl Int. 2018 Aug;31(8):867-869. - PMID 29480973 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:31 |
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| Enthalten in: |
Transplant international : official journal of the European Society for Organ Transplantation - 31(2018), 8 vom: 11. Aug., Seite 887-899 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Fernández-Ruiz, Mario [VerfasserIn] |
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| Links: |
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| Themen: |
Antiviral Agents |
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| Anmerkungen: |
Date Completed 14.11.2018 Date Revised 17.03.2022 published: Print-Electronic CommentIn: Transpl Int. 2018 Aug;31(8):867-869. - PMID 29480973 Citation Status MEDLINE |
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| doi: |
10.1111/tri.13118 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM280179332 |
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| 100 | 1 | |a Fernández-Ruiz, Mario |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Impact of anti-HCV direct antiviral agents on graft function and immunosuppressive drug levels in kidney transplant recipients |b a call to attention in the mid-term follow-up in a single-center cohort study |
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| 500 | |a CommentIn: Transpl Int. 2018 Aug;31(8):867-869. - PMID 29480973 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2018 Steunstichting ESOT. | ||
| 520 | |a The medium-term impact on graft function and immunosuppressive drug pharmacokinetics of direct antiviral agents (DAAs) among hepatitis C virus (HCV)-infected kidney transplant (KT) recipients remain unclear. We compared pre- and post-treatment 12-month trajectories of estimated glomerular filtration rate (ΔeGFR) and 24-h proteinuria (Δ24-h proteinuria) in 49 recipients treated with DAAs (mostly sofosbuvir plus ledipasvir). Among evaluable patients, 66.7% and 100.0% had undetectable viral load by week 4 and end of therapy (EoT). The sustained virologic response rate at 12 weeks was 95.8%. Overall, 80.6% of patients receiving tacrolimus required dose escalation while on DAA-based therapy (median increase of 66.7%) to maintain target levels. Tacrolimus levels resulted to be higher at 12 months compared to EoT (7.8 ± 2.1 vs. 6.7 ± 2.0 ng/ml; P-value = 0.002). No changes in graft function during the course of therapy were observed. However, eGFR significantly decreased (P-value <0.001) throughout the first 12 months after EoT. Median ΔeGFR and Δ24-h over pre- and post-treatment periods were 3.9% and -6.1% (P-value = 0.002) and -5.3% and 26.2% (P-value = 0.057). Caution should be exercised when adjusting immunosuppression in HCV-infected KT recipients upon initiation of DAAs, followed by mid-term monitoring of immunosuppressive drug levels and graft function | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a direct antiviral agents | |
| 650 | 4 | |a hepatitis C virus | |
| 650 | 4 | |a kidney transplantation | |
| 650 | 4 | |a medium-term graft function | |
| 650 | 4 | |a therapeutic drug monitoring | |
| 650 | 7 | |a Antiviral Agents |2 NLM | |
| 700 | 1 | |a Polanco, Natalia |e verfasserin |4 aut | |
| 700 | 1 | |a García-Santiago, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Muñoz, Raquel |e verfasserin |4 aut | |
| 700 | 1 | |a Hernández, Ana M |e verfasserin |4 aut | |
| 700 | 1 | |a González, Esther |e verfasserin |4 aut | |
| 700 | 1 | |a Mercado, Verónica R |e verfasserin |4 aut | |
| 700 | 1 | |a Fernández, Inmaculada |e verfasserin |4 aut | |
| 700 | 1 | |a Aguado, José María |e verfasserin |4 aut | |
| 700 | 1 | |a Praga, Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Andrés, Amado |e verfasserin |4 aut | |
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