I nuovi farmaci antivirali per la terapia di HCV post-trapianto renale

Translated title of the contribution: Novel antiviral agents for the treatment of HCV among renal transplant recipients

Research output: Contribution to journalReview articlepeer-review

Abstract

The frequency of hepatitis C virus infection remains high in renal transplant recipients and plays a detrimental role on survival in this population. According to the latest evidence, the adjusted relative risk of mortality and graft loss for anti-HCV seropositive versus anti-HCV negative renal transplant recipients was 1.85 with a 95% confidence interval (CI) of 1.49 ; 2.31 (P < 0.0001) and 1.76 (95% CI, 1.46 ; 2.11) (P < 0.0001), respectively. Interferon-based regimens have been recommended for the treatment of hepatitis C after renal transplantation only in selected circumstances because of an increased risk of acute rejection due to the immuno-stimulatory properties of interferon. Limited data exist on the treatment of HCV with direct-acting antiviral agents among kidney transplant recipients. To date, the most important evidence comes from the European multicenter study where a large cohort (n=114) of patients with glomerular filtration rate of 40 mL/min/1.73m² received an interferon-free, ribavirin-free combination of direct-acting antivirals (Ledipasvir/Sofosbuvir) for 12 or 24 weeks. A high efficacy [SVR12 rate, 100% (114/114) ] was found even if three serious adverse were observed ; all were determined to be treatment related, one patient interrupted permanently treatment. Also, single-center single-arm observational studies have reported high efficacy and safety of sofosbuvir-based combinations for the treatment of HCV after renal transplant. A decline in through levels of calcineurin inhibitors after completion of antiviral therapy has been found in many patients; an enhanced metabolism of calcineurin inhibitors associated with resolution of liver injury has been suggested. An effective and safe therapy for HCV in kidney transplant recipients might improve the current suboptimal utilization of HCV-positive kidney donors and provide many patients with end-stage renal disease access to HCV-infected donor kidneys.

Translated title of the contributionNovel antiviral agents for the treatment of HCV among renal transplant recipients
Original languageItalian
Pages (from-to)35-50
Number of pages16
JournalGiornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia
Volume34
Issue number4
Publication statusPublished - Aug 1 2017

ASJC Scopus subject areas

  • Medicine(all)

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