A recent study reported that DAA therapy was very effective for kidney transplant recipients, who had HCV before the transplantation. DAA end-of-treatment response (ETR) led to such a decrease in HCV recurrence post-kidney transplant, according to the Nature study.
The 50-person cohort trial of HCV patients treated with DAA medications before kidney transplant reported an HCV non-recurrence rate of 95.8%. This implies that people with kidney disease who respond to treatment can have kidney transplants with confidence, which is less likely to be the case with reinfection.
HCV, a global health problem, affects 58 million people chronically, and 1.5 million of them get new cases annually. DAA therapy is considered curative, being effective in over 95% of HCV patients, but so far, the efficacy of DAA in transplant recipients has not been well investigated.
Farina Muhammad Hanif, MBBS, an assistant professor at the Sindh Institute of Urology and Transplantation (SIUT), is conducting a study to shed light on the issue of HCV recurrence in renal transplant recipients who had previously received effective treatment for it.
The literature has shown that extended dialysis for a long time to achieve a sustained virological response may result in a higher risk of recurrence of the breakthrough, de novo HCV infection, and comorbidities.
The patients under 50 years of age who were treated with the DAA drugs before the transplantation were the study subjects. Three months after the transplant, they tested the HCV PCR levels for recurrence. Of the group of 432 patients who had an operation 1.5 years ago, 48 of them were given DAAs to treat their HCV.
All patients who received a treatment regimen of sofosbuvir, daclatasvir, and ribavirin before transplant, improved favourably. Due to the slow response of viruses, just 5% of patients have to take DAA for an extended period of time.
Pre- and post-transplant measurements of total bilirubin, alanine aminotransferase, and haemoglobin levels showed appropriate changes, proving that the patient was healthy.
Importantly, only 2 of 48 renal transplant recipients had HCV PCR detectable at posttransplant, and both of them died of graft failure and cryptococcal meningitis.
The research is the first to evaluate DAA response in patients on a waiting list for kidney transplantation who have been enrolled early in the transplantation program, which supports the concept that dialysis patients can safely be transferred to transplantation following the end-of-treatment response. This ground-breaking result leads to HCV treatment selection in special patient groups and encourages patients with post-transplantation HCV.
