eISSN: 2345-4202  
J Nephropharmacol. 2017;6(2):49-61.
doi:10.15171/npj.2017.04

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Efficacy and safety of direct-acting antivirals for treatment of hepatitis C infected kidney transplant recipients; a meta-analysis

Wisit Cheungpasitporn 1 * , Charat Thongprayoon 2, Karn Wijarnpreecha 2, Ankit Sakhuja 3, Wonngarm Kittanamongkolchai 1, Jackrapong Bruminhent 4

1 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
2 Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
3 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
4 Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
*Corresponding author: Wisit Cheungpasitporn MD, Email: wcheungpasitporn@1gmail.com

Abstract

The use of direct-acting antivirals (DAAs) for treatment of hepatitis C virus (HCV) infection has been shown to very effective. However, its efficacy and tolerability in kidney transplant recipients are unclear. A literature search was performed using MEDLINE, EMBASE, and Cochrane Databases from inception through January 2017. We included studies that reported crude numbers of kidney transplant patients who achieved sustained virological response (SVR) or developed adverse effects with DAA therapy. Pooled estimated rates of SVR at 12 weeks (SVR12) after DAA therapy and discontinuation rate of DAAs treatment with 95% confidence interval (CI) were assessed using a random-effect, generic inverse variance method. The study protocol is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017054575). Around, 24 studies with 892 kidney transplant recipients were included in the meta-analysis. The pooled estimated SVR12 rate with DAAs treatment for HCV among kidney transplant patients was 97% (95% CI: 95%-99%; I2 = 22%). The pooled estimated rate of discontinuation of DAAs treatment for HCV among kidney transplant patients was 2% (95% CI: 1%-3%; I2 = 0%). Reported treatment-related serious adverse events included bradycardia with syncope in the co-administration of sofosbuvir with amiodarone, pulmonary embolism, gastrointestinal bleeding, portal vein thrombosis, bacteremia, anemia particularly with regimens including ribavirin, and uncommonly increased serum creatinine. The findings of our study suggest excellent efficacy and tolerability profiles of DAA therapy for HCV infection in kidney transplant patient populations.
Implication for health policy/practice/research/medical education:
The efficacy and tolerability of direct-acting antivirals (DAAs) therapy for HCV infection in kidney transplant recipients are unclear. In this meta-analysis including 24 studies with 892 kidney transplant recipients, we demonstrate excellent efficacy and tolerability profiles with estimated SVR12 rate of 97% and estimated rate of discontinuation of DAAs of 2%.
Please cite this paper as: Cheungpasitporn W, Thongprayoon C, Wijarnpreecha K, Sakhuja A, Kittanamongkolchai W, Gonzalez-Suarez ML, Bruminhent J. Efficacy and safety of direct-acting antivirals for treatment of hepatitis C infected kidney transplant recipients; a meta-analysis. J Nephropharmacol. 2017;6(2):49-61. DOI: 10.15171/npj.2017.04.
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Submitted: 29 Dec 2016

Accepted: 07 Mar 2017
First published online: 06 Mar 2017
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