Application Of Direct Antiviral Agents In Patients With Hepatitis C Virus After Renal Transplantation

Purpose: With the development of direct antiviral agents(DAAs)and the safety and effectiveness of non-interferon all-oral antiviral regimens reported by some centers,the prevention and treatment of viral hepatitis C has changed dramatically.However,due to the use of immunosuppressive drugs and the susceptibility to infection in kidney transplant patients have made the use of such drugs in this type of patient has become a current research focus.This article retrospectively analyzes the cases in our center to assessing the safety and effectiveness of direct antiviral drugs in patients who suffered from hepatitis C virus undergoing kidney transplantation,receiving HCV-IgG antibodies(+)and HCV infection in patients with end-stage renal disease.Methods : Retrospectively analyzing clinical data of patients with end-stage renal disease who underwent allograft kidney transplantation at our organ transplantation center from 2010 to 2019.Relevant examinations and preoperative preparations were completed before surgery,and HCV nucleic acid detection and genotyping were improved for patients with HCV antibody positive.All patients received non-interferon all-oral antiviral regimens after surgery.The blood routine,renal function,liver function,and blood drug concentration of immunosuppressive drugs were reviewed once a week and check the serum HCV RNA quantification every 4 weeks.Patients receiving HCV infection and HCV-IgG(+)donor kidneys will be reviewed for HCV-IgG every four weeks.The safety of antiviral drugs was assessed by comparing changes in serum creatinine,immunosuppressive drug trough concentrations,and adverse event records during and after oral antiviral treatment.At the same time,the effectiveness of the drug was evaluated by quantitative changes in HCV RNA and decreased levels of serum transaminase.Results: A total of 12 patients were included in the study,of which 9 were HCV infected patients undergoing kidney transplantation,1 was receiving HCV-IgG(+)donor kidney,and 2 were receiving type 6a HCV infection donor kidneys.1.Nine patients with HCV infection who underwent renal transplantation and DAAs were started approximately 2 to 50 months(median time: 33 months)after renal transplantation.Before treatment,the viral load was 4.74 × 105 ~ 3.20 × 107 IU / mL,the glomerular filtration rate was> 30 ml /(min · 1.73 ?),and the transplanted kidney function was stable.Eight patients received rapid virological response(RVR)after antiviral treatment,and one patient received early virological response(EVR).The levels of serum transaminase in all patients were lower than before treatment,and the difference was statistically significant(P <0.05).There was no significant change in serum creatinine before and after treatment,and the difference was not statistically significant(P> 0.05).There was no significant change in the concentration of immunosuppressive drugs during the course of treatment.One patient developed pneumocystis pneumonia during treatment,which resulted in an increase in serum creatinine.After treatment with anti-infection,the function of the transplanted kidney recovered to the level before infection.One patient developed dizziness during treatment and was treated for symptomatic supportive care after excluding other diseases.2.1 patients who were not infected with HCV received HCV-IgG(+)donor kidney and received oral sofosbuvir + vepatasvir antiviral therapy 2 weeks after surgery.HCV RNA and HCV-IgG did not show positive expression after operation,and serum creatinine was not significantly abnormal during the period.3.2 patients received type 6a HCV-infected kidneys and started oral sofosbuvir + vepatasvir antiviral therapy in the first week after surgery.No positive expression of HCV RNA was detected after multiple postoperative tests,but HCV-IgG was positive at 4 weeks after operation.During the period,there was no significant change in serum creatinine,and serum transaminase levels were lower than before treatment,and the difference was statistically significant(P <0.05).Conclusion:This study draws the following conclusions through the clinical experience of our center:1.This is a retrospective study of a small sample.The DAAs protocol for all patients is limited to sofosbuvir and drugs containing sofosbuvir.The results are not universal.2.Due to the limitations of genotypes,whether this result is applicable to patients with other genotypes still needs to be determined through larger prospective studies.3.For patients with HCV-infected end-stage renal disease,There is currently no unified standard for the choice of HCV treatment before or after transplantation,and careful consideration and monitoring of drug-drug interactions.4.According to the clinical experience of our center,it is relatively safe to receive HCV-infected kidneys after the timely use of DAAs after surgery.