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

Author(s):  
Liz Toapanta - Yanchapaxi ◽  
Erwin Chiquete ◽  
Víctor Manuel Páez-Zayas ◽  
Juan Francisco Sánchez-Ávila ◽  
Alan G. Contreras - Saldívar ◽  
...  

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.

2006 ◽  
Vol 12 (11) ◽  
pp. 1649-1654 ◽  
Author(s):  
Valérie Bardet ◽  
Alcindo Pissaia Junior ◽  
Joël Coste ◽  
Carinne Lecoq-Lafon ◽  
Sandrine Chouzenoux ◽  
...  

2011 ◽  
Vol 43 (4) ◽  
pp. 1136-1138 ◽  
Author(s):  
F. Tinti ◽  
I. Umbro ◽  
V. Giannelli ◽  
M. Merli ◽  
S. Ginanni Corradini ◽  
...  

2004 ◽  
Vol 10 (2) ◽  
pp. 199-207 ◽  
Author(s):  
Manal F. Abdelmalek ◽  
Roberto J. Firpi ◽  
Consuelo Soldevila-Pico ◽  
Alan I. Reed ◽  
Alan W. Hemming ◽  
...  

2021 ◽  
Vol 8 ◽  
pp. 205435812110297
Author(s):  
Jean Maxime Côté ◽  
Isabelle Ethier ◽  
Héloïse Cardinal ◽  
Marie-Noëlle Pépin

Background: Chronic kidney disease following liver transplantation is a major long-term complication. Most liver transplant recipients with kidney failure will be treated with dialysis instead of kidney transplantation due to noneligibility and shortage in organ availability. In this population, the role of peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) remains unclear. Objective: To determine the feasibility regarding safety, technique survival, and dialysis efficiency of PD in liver transplant recipients requiring KRT for maintenance dialysis. Design: Systematic review. Setting: Interventional and observational studies reporting the use of PD after liver transplantation. Patients: Adult liver transplant recipients with kidney failure treated with maintenance KRT. Measurements: Extracted data included eligibility criteria, study design, demographics, and PD modality. The following outcomes of interest were extracted: rate of peritonitis and microorganisms involved, noninfectious peritoneal complications, technique survival, and kidney transplantation-censored technique survival. Non-PD complications included overall survival, liver graft dysfunction, and hospitalization rate. Methods: The following databases were searched until July 2020: MedLine/PubMed, EMBASE, CINAHL, and Cochrane Library. Two reviewers independently screening all titles and abstracts of all identified articles. Due to the limited sample size, observational designs and study heterogeneity expected, no meta-analysis was pre-planned. Descriptive statistics were used to report all results. Results: From the 5263 identified studies, 4 were included in the analysis as they reported at least 1 outcome of interest on a total of 21 liver transplant recipients, with an overall follow-up duration on PD of 19.0 (Interquartile range [IQR]: 9.5-29.5) months. Fifteen episodes of peritonitis occurred in a total cumulative PD follow-up of 514 patient-months, representing an incidence rate of 0.35 per year. These episodes did not result in PD technique failure, mortality, or impairment of liver graft function. Limitations: Limitations include the paucity of studies in the field and the small number of patients included in each report, a risk of publication bias and the impossibility to directly compare hemodialysis to PD in this population. These results, therefore, must be interpreted with caution. Conclusions: Based on limited data reporting the feasibility of PD in liver transplant recipients with kidney failure, no signal was associated with an increased risk of infectious complications. Long-term studies evaluating this modality need to be performed. Registration (PROSPERO): CRD42020218374.


Sign in / Sign up

Export Citation Format

Share Document