Direct-acting antivirals in the treatment of hepatitis C virus infection in renal transplant recipients: A single-center experience from South India

Introduction: Direct-acting antivirals (DAAs) are widely used in the treatment of hepatitis C virus (HCV) infection in renal transplant recipients. Aim: The aim was to study the efficacy and safety of these drugs in our renal transplant recipients. Study Design, Subjects, and Methods: A retrospective observational study was performed among the renal transplant recipients > 18 years of age who were treated with DAA for HCV infection. The viral genotype, DAA regimen, the viral load at various time intervals, FibroScan score at the start and at the end of therapy, the changes in graft function (estimated glomerular filtration rate) and in the dosage of calcineurin inhibitors during therapy, and side effects if any during therapy were documented from history and transplant records. The viral remission rates and the safety of DAA were analyzed. Statistical analysis was done with Medcalc statistical software version 12.7.0.0. Results: Thirty-three recipients were included in the study. The DAA regimens were sofosbuvir + ledipasvir (n = 17), sofosbuvir + daclatasvir (n = 8), and sofosbuvir + ribavirin (n = 8). The most common genotype was genotype 1 (n = 30, 90.9%). End-of-therapy response and sustained viral remission (SVR) at 12 weeks of completion of therapy (SVR12) were 100% in all the three DAA regimens. About 75% (n = 6) of the patients who underwent ribavirin therapy developed anemia, unlike the ribavirin-free regimens which had no side effects. The graft function remained stable during DAA therapy. At a mean follow-up of 3 years after initiation of sofosbuvir + ribavirin therapy and 2 years after initiation of sofosbuvir + daclatasvir and sofosbuvir + ledipasvir therapy, the viral remission was sustained. Conclusion: DAAs are safe and effective in achieving and sustaining viral remission in renal transplant recipients.