Hepatitis C virus can be eliminated from a prevalent kidney transplant recipient population: a single-centre study in the direct-acting antivirals era

Devresse, Arnaud;Delire, Bénédicte;Lazarus, Jeffrey V;Kabamba-Mukadi, Benoît;Kanaan, Nada;et.al.
(2019) 19th Congress of the European Society for Organ Transplantation (ESOT) — Location: Copenhagen, Denmark (15.September.2019)

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Background: Direct-acting antivirals (DAAs) have recently revolutionized the treatment of hepatitis C (HCV) infection. Although previous studies have reported positive results with DAAs after kidney transplantation (KT), its impact on the real-world prevalence of HCV viremia in prevalent kidney transplant recipients (KTR) remains ill-defined. Methods: We retrospectively reviewed the HCV status (serology, polymerase chain reaction) of all KTR followed at our outpatient KT clinic between 01/2014 and 12/2018 (n = 1451). We calculated the evolution of the prevalence of HCV viremia (HCVv) over this period and reviewed the clinical features of KTR treated with DAAs while having a functioning graft. Results: Out of 1451 KTR, 22 (1.52%) had HCVv while having a functioning graft in 2014-18. From 2014 to 2018, annual prevalence of HCVv dropped from 1.97% to 1.81%, 1.77%, 1.79% and 0.43%, respectively (p < 0.001). Fourteen KTR were treated with DAAs (sofosbuvir/velpatasvir, n = 4; elbasvir/grazoprevir, n = 5; sofosbuvir/daclatasvir, n = 2; sofosbuvir/ledipasvir, n = 2; ombitasvir/paritaprevir/dasabuvir, n = 1), a median of 197 months (ranges: 5-374) after KT, mostly (79%) in 2017 after reimbursement of DAAs for KTR in Belgium. None of the treated KTR experienced graft loss, acute rejection, de novo donor specific antibody occurrence or allograft dysfunction during or after DAAs treatment; however, 2 patients died 14 months (B-cell lymphoma, despite sustained virological response (SVR) at 12 weeks after treatment) and 7 months (metastatic hepatocarcinoma, no SVR12) after DAAs initiation, respectively. SVR12 rate was 93%. Among HCVv KTR not treated with DAAs (n = 8), 2 lost their graft and 5 died. The current prevalence of HCVv in our cohort is 0.08% with a single patient to treat (ongoing). Conclusion: The increased use of DAAs led to a dramatic decrease of HCVv prevalence in our cohort of KTR. DAAs use was safe and effective. The elimination of HCV in prevalent KTR is now possible.
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Devresse, A., Delire, B., Lazarus, J. V., Kabamba-Mukadi, B., De Meyer, M., Mourad, M., Buemi, A., Darius, T., Cambier, J.-F., Goffin, E., Jadoul, M., & Kanaan, N. (2019). Hepatitis C virus can be eliminated from a prevalent kidney transplant recipient population: a single-centre study in the direct-acting antivirals era. Transplant International, 32(S2), 121. https://doi.org/10.1111/tri.13507 (Original work published 2019)