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The interferon and ribavirin treatment for HCV infection in kidney transplant recipients is limited&#44; because of the risk for allograft rejection and poor tolerability&#46; In 2011 the U&#46;S&#46; Food and Drug Administration approved the introduction of direct-acting antiviral agents &#40;DAAs&#41; for the treatment of chronic HCV infection&#46; Since 2014&#44; in the European Union&#44; Sofosbuvir &#40;SOF&#41; 400<span class="elsevierStyleHsp" style=""></span>mg&#47;Ledipasvir &#40;LDV&#41; 90<span class="elsevierStyleHsp" style=""></span>mg &#40;Harvoni<span class="elsevierStyleSup">&#174;</span>&#41; is licensed for chronic HCV infection therapy&#46; According to the EASL Guidelines&#44; no dose adjustment of SOF&#47;LDV is required for patients with mild or moderate renal impairment &#40;estimated glomerular filtration rate &#91;eGFR&#93;<span class="elsevierStyleHsp" style=""></span>&#62;30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; and a full-dose SOF is recommended in patients with stage 5 chronic kidney disease &#40;CKD&#41; on dialysis&#59; however&#44; the safety has not been assessed in patients with stage 4 or 5 CKD not on dialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In the experience of Saxena et al&#46;&#44; a progressive deterioration of renal function and renal symptoms was reported in patients with eGFR &#8804;45<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> receiving an SOF-based regimen&#44; although efficacy was comparable to that observed in patients without renal impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The experience of DAA therapy for HCV in the post kidney transplant setting is poor and limited than in liver transplant recipients&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> There has been a concern that HCV-positive recipients of HCV-positive kidneys have worse clinical outcomes compared to HCV-positive recipients of HCV-negative grafts&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Here we report our experience&#46; In September 2015 a 54-year-old female&#44; suffering from ADPKD&#44; on long-term hemodialysis&#44; became HCV-positive &#40;genotype 1b&#44; viral load 1&#44;260&#44;000<span class="elsevierStyleHsp" style=""></span>UI&#47;ml&#41;&#44; without abnormal liver laboratory investigations&#46; In November 2015 she successfully received a renal transplant from HCV-positive &#40;genotype 1b&#44; viral load 960&#44;000<span class="elsevierStyleHsp" style=""></span>UI&#47;ml&#41; deceased donor&#44; with early functioning graft &#40;creatinine 0&#46;66<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46; From March to May 2016 she received anti-HCV therapy&#46; She was taking prednisone&#44; everolimus and tacrolimus&#46; She was treated with SOF&#47;LDV 1 tablet&#47;day for 12 weeks&#46; At the baseline &#40;January 2016&#41;&#44; the viral load was 18&#44;770&#44;000<span class="elsevierStyleHsp" style=""></span>UI&#47;ml&#46; The patient had a Sustained Virological Response at 12 and 24 weeks after treatment&#46; In this period&#44; she did not suffer from any of the most common adverse events of SOF&#47;LDV treatment &#40;fatigue&#44; headache&#44; anemia requiring blood transfusion&#44; nausea&#41;&#44; and we did not observe any abnormalities of the common laboratory parameters&#46; At follow-up &#40;February 2018&#41;&#44; the HCV-RNA detection was negative&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our experience confirms the positive results by Gallegos-Orozco JF et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> We highlight the efficacy of antiviral therapy in a HCV-positive &#40;with active HCV-RNA replication&#41; renal transplant recipient from HCV-positive donor&#44; without severe adverse events or drug&#8211;drug interactions with her immunosuppressive therapy&#46;</p></span>"
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Letter to the Editor
The efficacy of antiviral therapy after renal transplant in a HCV-positive recipient from a HCV-positive donor
La eficacia de la terapia antiviral después del trasplante renal en un receptor con HCV positivo de un donante con HCV positivo
Gioacchino Li Cavoli
Corresponding author
gioacchinolicavoli@libero.it

Corresponding author.
, Camillo Carollo, Barbara Oliva, Antonio Amato, Rosa Anna Turdo, Vitalba Azzolina, Rosalia Mongiovì, Flavia Caputo
Nephrology Dialysis and Renal Transplant Department, Civico and Di Cristina Hospital, Palermo, Italy
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the general population&#44; the Hepatitis C virus &#40;HCV&#41; infection is a leading public health problem worldwide&#59; in patients on long-term hemodialysis the prognosis of HCV-infected patients is significantly worse than in patients without HCV infection&#59; in renal transplant recipients this infection is responsible for both hepatic &#40;mainly hepatocellular carcinoma and chronic hepatitis&#41; and extra-hepatic complications &#40;transplant glomerulopathy&#44; HCV-related glomerular disease&#44; acute rejection&#44; new onset diabetes after transplant&#44; cardiovascular disease&#44; infections&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> HCV-positive patients with kidney transplant have increased risk of graft loss&#44; increased morbidity and mortality rate compared to HCV-negative recipients&#46; The interferon and ribavirin treatment for HCV infection in kidney transplant recipients is limited&#44; because of the risk for allograft rejection and poor tolerability&#46; In 2011 the U&#46;S&#46; Food and Drug Administration approved the introduction of direct-acting antiviral agents &#40;DAAs&#41; for the treatment of chronic HCV infection&#46; Since 2014&#44; in the European Union&#44; Sofosbuvir &#40;SOF&#41; 400<span class="elsevierStyleHsp" style=""></span>mg&#47;Ledipasvir &#40;LDV&#41; 90<span class="elsevierStyleHsp" style=""></span>mg &#40;Harvoni<span class="elsevierStyleSup">&#174;</span>&#41; is licensed for chronic HCV infection therapy&#46; According to the EASL Guidelines&#44; no dose adjustment of SOF&#47;LDV is required for patients with mild or moderate renal impairment &#40;estimated glomerular filtration rate &#91;eGFR&#93;<span class="elsevierStyleHsp" style=""></span>&#62;30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; and a full-dose SOF is recommended in patients with stage 5 chronic kidney disease &#40;CKD&#41; on dialysis&#59; however&#44; the safety has not been assessed in patients with stage 4 or 5 CKD not on dialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In the experience of Saxena et al&#46;&#44; a progressive deterioration of renal function and renal symptoms was reported in patients with eGFR &#8804;45<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> receiving an SOF-based regimen&#44; although efficacy was comparable to that observed in patients without renal impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The experience of DAA therapy for HCV in the post kidney transplant setting is poor and limited than in liver transplant recipients&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> There has been a concern that HCV-positive recipients of HCV-positive kidneys have worse clinical outcomes compared to HCV-positive recipients of HCV-negative grafts&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Here we report our experience&#46; In September 2015 a 54-year-old female&#44; suffering from ADPKD&#44; on long-term hemodialysis&#44; became HCV-positive &#40;genotype 1b&#44; viral load 1&#44;260&#44;000<span class="elsevierStyleHsp" style=""></span>UI&#47;ml&#41;&#44; without abnormal liver laboratory investigations&#46; In November 2015 she successfully received a renal transplant from HCV-positive &#40;genotype 1b&#44; viral load 960&#44;000<span class="elsevierStyleHsp" style=""></span>UI&#47;ml&#41; deceased donor&#44; with early functioning graft &#40;creatinine 0&#46;66<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46; From March to May 2016 she received anti-HCV therapy&#46; She was taking prednisone&#44; everolimus and tacrolimus&#46; She was treated with SOF&#47;LDV 1 tablet&#47;day for 12 weeks&#46; At the baseline &#40;January 2016&#41;&#44; the viral load was 18&#44;770&#44;000<span class="elsevierStyleHsp" style=""></span>UI&#47;ml&#46; The patient had a Sustained Virological Response at 12 and 24 weeks after treatment&#46; In this period&#44; she did not suffer from any of the most common adverse events of SOF&#47;LDV treatment &#40;fatigue&#44; headache&#44; anemia requiring blood transfusion&#44; nausea&#41;&#44; and we did not observe any abnormalities of the common laboratory parameters&#46; At follow-up &#40;February 2018&#41;&#44; the HCV-RNA detection was negative&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our experience confirms the positive results by Gallegos-Orozco JF et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> We highlight the efficacy of antiviral therapy in a HCV-positive &#40;with active HCV-RNA replication&#41; renal transplant recipient from HCV-positive donor&#44; without severe adverse events or drug&#8211;drug interactions with her immunosuppressive therapy&#46;</p></span>"
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                      "titulo" => "Treatment with ledipasvir-sofosbuvir for 12 or 24 weeks in kidney transplant recipients with chronic hepatitis C virus genotype 1 or 4 infection&#58; a randomized trial"
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Article information
ISSN: 20132514
Original language: English
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2022 December 35 36 71
2022 November 41 32 73
2022 October 38 46 84
2022 September 30 43 73
2022 August 45 37 82
2022 July 66 48 114
2022 June 33 28 61
2022 May 74 34 108
2022 April 40 37 77
2022 March 52 53 105
2022 February 42 46 88
2022 January 63 41 104
2021 December 62 33 95
2021 November 40 40 80
2021 October 42 51 93
2021 September 26 39 65
2021 August 61 35 96
2021 July 62 38 100
2021 June 19 21 40
2021 May 27 51 78
2021 April 62 78 140
2021 March 50 29 79
2021 February 46 29 75
2021 January 36 17 53
2020 December 24 13 37
2020 November 15 14 29
2020 October 30 23 53
2020 September 21 18 39
2020 August 43 15 58
2020 July 14 12 26
2020 June 19 15 34
2020 May 15 11 26
2020 April 14 11 25
2020 March 20 11 31
2020 February 14 13 27
2020 January 20 27 47
2019 December 22 21 43
2019 November 18 12 30
2019 October 17 13 30
2019 September 18 12 30
2019 August 21 10 31
2019 July 25 25 50
2019 June 4 3 7
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?