Adjustment of Immunosuppression for Liver Transplant Recipients Infected with HCV and Treated with Paritaprevir / Ritonavir - Ombitasvir/ Dasabuvir and Ribavirin

Abstract

Introduction. Eradication rates of hepatitis C virus (HCV) infection is likely to rise after liver transplantation (LT). We aimed to evaluate the clinical role of a simple method for calcineurin inhibitors (CNI) adjustment in post-LT patients receiving paritaprevir / ritonavir / ombitasvir / dasabuvir and ribavirin (3D scheme). Material and Methods. We included post-LT adult patients between 2014 and 2017. All selected subjects had at least a 12-month follow-up receiving a stable dose of a CNI. All patients had HCV-1 infection, no liver cirrhosis and received the 3D scheme for 24 weeks. Serial blood concentration measurements of immunosuppressant drugs were obtained. CNI dose was adjusted since 3D scheme initiation and during follow-up until adequate levels were obtained. Results. A total of 10 LT patients (mean age 58.7 ± 11.26 years, 60 % women), out of LT 22, received the 3D regime. Tacrolimus was used in 9 patients: four patients received a dose of 0.5 mg every 10 days and 5 received doses of 0.25 mg every 5 days (mean levels, 9.07 ± 5.56 ng/mL). The trough concentration (Ctrough) was 2 ng / mL and the maximum concentration (Cmax) was 30 ng / mL. Only one patient was treated with cyclosporine (mean blood levels of 152.85 ± 54.55 ng / mL). All cases exhibited a sustained viral response. Discussion and Conclusions. It is possible to adjust CNI in LT patients under the 3D regime, with high response rates. Low CNI doses are required to avoid toxicity and side effects in HCV patients receiving protease inhibitors.