Direct-acting Antivirals in Kidney Transplant Patients: Successful Hepatitis C Treatment and Short Term Reduction in Urinary Protein/Creatinine Ratios

Abstract

Introduction: The role of Hepatitis C Virus (HCV) clearance in long-term kidney graft survival is unknown. In this study, we examined short-term trends of urinary protein/creatinine (P/C) ratios in a cohort of HCV-infected kidney transplant recipients with stable graft function and treated with direct-acting antivirals (DAAs).Methods: We conducted a retrospective study of 19 kidney transplant patients with chronic HCV infection treated with DAAs at the University of Alabama at Birmingham 1917 Viral Hepatitis Clinic between January 2013 and June 2016. Markers of glomerular damage were assessed using average protein/creatinine (P/C) ratios measured pre- and post-treatment. We also described treatment efficacy using sustained virologic response at 12 weeks post-HCV treatment (SVR12).Results: The median age of the 19 patients included was 59 years (Q1=58, Q3=64) at completion of treatment. Of these patients, 68% were African American, 32% were White and 63% were male. The median time between kidney transplant and initiation of DAA therapy was 2.25 years (Q1=0.79, Q3=3.79). Post-treatment P/C ratios (median=0.127, Q1=0.090, Q3=0.220) were significantly lower (p=0.01) than pre-treatment ratios (median=0.168, Q1=0.118, Q3=0.385). P/C ratios decreased in 14 of 19 patients (74%) with median change of -0.072 (median percent change= -40%). Post-treatment eGFRs (median=58.9, Q1=48.9, Q3=72.3) were not significantly different (p=0.82) than the pre-treatment values (median=57.0, Q1=48.8, Q3=67.8).Conclusions: In this preliminary study, there was a statistically significant decrease in P/C ratios associated with HCV clearance, suggesting a potential role for DAAs in improving kidney graft survival. Larger cohort studies will be needed to assess the clinical and long-term benefits of DAAs in this special population of HCV infected patients.