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

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Michael R. Goetsch
Ashutosh Tamhane
Mohit Varshney
Anuj Kapil
Edgar T. Overton
Graham C. Towns
Ricardo A. Franco


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. 


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Author Biography

Ricardo A. Franco, Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham

Dr. Franco is board certified in Internal Medicine and Infectious Diseases and Assistant Professor of Medicine at the University of Alabama at Birmingham. His interest focuses on interventions to improve access to care and new therapies in Chronic Hepatitis C; clinical management and trials in HCV mono-infection and HIV-HCV co-infection; and the accelerated pathogenesis of HIV-HCV co-infection. Recently, Dr. Franco had coordinated the Hep C Circle of Care award, instrumental in the expansion of the 1917 Viral Hepatitis Clinic. Since then, the 1917 Viral Hepatitits Clinic had developed collaborations with the Liver Center, the Department of Emergency Medicine and Charity Care at UAB, becoming a major point of linkage to Hepatitis C care for a broad referral base in the State of Alabama.


1. Poynard T, Yuen MF, Ratziu V, Lai CL. Viral hepatitis C. Lancet. 2003;362(9401):2095-100. PubMed PMID: 14697814.

2. Lee JJ, Lin MY, Chang JS, Hung CC, Chang JM, Chen HC, Yu ML, Hwang SJ. Hepatitis C virus infection increases risk of developing end-stage renal disease using competing risk analysis. PLoS One. 2014;9(6):e100790. PubMed PMID: 24971499. Pubmed Central PMCID: 4074067. doi: 10.1371/journal.pone.0100790

3. Baid-Agrawal S, Farris AB, 3rd, Pascual M, Mauiyyedi S, Farrell ML, Tolkoff-Rubin N, Collins AB, Frei U, Colvin RB. Overlapping pathways to transplant glomerulopathy: chronic humoral rejection, hepatitis C infection, and thrombotic microangiopathy. Kidney Int. 2011;80(8):879-85. PubMed PMID: 21697808. doi:

4. Cruzado JM, Carrera M, Torras J, Grinyo JM. Hepatitis C virus infection and de novo glomerular lesions in renal allografts. Am J Transplant. 2001;1(2):171-8. PubMed PMID: 12099366.

5. Belga S, Doucette KE. Hepatitis C in non-hepatic solid organ transplant candidates and recipients: A new horizon. World J Gastroenterol. 2016;22(4):1650-63. PubMed PMID: 26819530. Pubmed Central PMCID: 4721996. doi: 10.3748/wjg.v22.i4.1650

6. Kidney Disease: Improving Global Outcomes. KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of Hepatitis C in chronic kidney disease. Guideline 4: Management of HCV-infected patients before and after kidney transplantation. Kidney Int 2008; 73(109): S53–S68. PubMed PMID: 18382440. doi: 10.1038/ki.2008.81

7. Baid-Agrawal S, Pascual M, Moradpour D, Somasundaram R, Muche M. Hepatitis C virus infection and kidney transplantation in 2014: what's new? Am J Transplant. 2014;14(10):2206-20. PubMed PMID: 25091274. doi: 10.1111/ajt.12835

8. Sawinski D, Kaur N, Ajeti A, Trofe-Clark J, Lim M, Bleicher M, Goral S, Forde KA, Bloom RD. Successful Treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents. Am J Transplant. 2016;16(5):1588-95. PubMed PMID: 26604182. doi: 10.1111/ajt.13620

9. Lin MV, Sise ME, Pavlakis M, Amundsen BM, Chute D, Rutherford AE, Chung RT, Curry MP, Hanifi JM, Gabardi S, Chandraker A, Heher EC, Elias N, Riella LV. Efficacy and Safety of Direct Acting Antivirals in Kidney Transplant Recipients with Chronic Hepatitis C Virus Infection. PLoS One. 2016;11(7):e0158431. PubMed PMID: 27415632. Pubmed Central PMCID: 4945034. doi: 10.1371/journal.pone.0158431

10. Fernandez I, Munoz-Gomez R, Pascasio JM, Baliellas C, Polanco N, Esforzado N, Arias A, Prieto M, Castells L, Cuervas-Mons V, Hernandez O, Crespo J, Calleja JL, Forns X, Londono MC. Efficacy and tolerability of interferon-free antiviral therapy in kidney transplant recipients with chronic hepatitis C. J Hepatol. 2017;66(4):718-23. PubMed PMID: 28039098. doi: 10.1016/j.jhep.2016.12.020

11. Cholongitas E, Pipili C, Papatheodoridis GV. Interferon-free regimens in patients with hepatitis C infection and renal dysfunction or kidney transplantation. World J Hepatol. 2017;9(4):180-90. PubMed PMID: 28217256. Pubmed Central PMCID: 5295158. doi: 10.4254/wjh.v9.i4.180

12. Lubetzky M, Chun S, Joelson A, Coco M, Kamal L, Ajaimy M, Gaglio P, Akalin E, De Boccardo G. Safety and Efficacy of Treatment of Hepatitis C in Kidney Transplant Recipients With Directly Acting Antiviral Agents. Transplantation. 2017;101(7):1704-10. PubMed PMID: 28009781. doi: 10.1097/TP.0000000000001618

13. Gentil MA, Gonzalez-Corvillo C, Perello M, Zarraga S, Jimenez-Martin C, Lauzurica LR, Alonso A, Franco A, Hernandez-Marrero D, Sanchez-Fructuoso A. Hepatitis C Treatment With Direct-Acting Antivirals in Kidney Transplant: Preliminary Results From a Multicenter Study. Transplant Proc. 2016;48(9):2944-6. PubMed PMID: 27932113. doi: 10.1016/j.transproceed.2016.07.034

14. Amer H, Cosio FG. Significance and management of proteinuria in kidney transplant recipients. J Am Soc Nephrol. 2009;20(12):2490-2. PubMed PMID: 19820126. doi: 10.1681/ASN.2008091005

15. Kidney Disease: Improving Global Outcomes. KDIGO clinical practice guidelines for the evaluation and management of chronic kidney disease. Kidney Int 2012. 3(1).http:/

16. Shamseddin MK, Knoll GA. Posttransplantation proteinuria: an approach to diagnosis and management. Clin J Am Soc Nephrol. 2011;6(7):1786-93. PubMed PMID: 21734095. doi: 10.2215/CJN.01310211