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Some kidney transplant recipients benefit from antiviral therapy

Friday March 15th, 2019

Antiviral therapy improves survival rates of kidney transplant patients infected with hepatitis B and C, French researchers reported last night.

The results of the research, which was carried out by scientists at Université Lille 2 and Inserm U795, Lille, has led to demands for the therapy to be systematically offered to all HBV and HCV patients.

Lead investigator Dr Philippe Mathurin, CHRU de Lille, Chief, Service des maladies de l’appareil digestif, Université Lille 2 and Inserm U795, Lille, and colleagues analysed records of more than 30,000 kidney transplant recipients using the French national database CRISTAL. This included 575 recipients with HBV, 1,060 with HCV, and 29,798 who were free from infection.

Writing in the Journal of Hepatology, the researchers describe comparing prognoses in these three groups and confirmed there was a poorer prognosis in HCV-infected patients than in non-infected patients.

They then carried out a random analysis of the medical records of 184 HBV and 504 HCV patients, which showed a control of viral replication in 94% and 35% of cases, respectively.

For each kidney transplant recipient with HCV with detectable or undetectable HCV RNA, researchers randomly selected one to four matched controls from the non-infected patients using the matching criteria of: gender, age, duration of dialysis, duration of cold ischemia, and year of transplantation.

This demonstrated that HBV chronic infection, which previously had a negative impact on patient and survival in kidney transplant patients, no longer influences patient or graft survival due to the control of viral replication related to the extensive use of nucleos(t)ide analogues.

The researchers found that HCV chronic infection still negatively impacts 10-year patient and graft survival, but that HCV’s negative influence is counteracted by sustained viral suppression.

“The control of viral replication is a key factor in kidney transplant recipients,” said Dr Mathurin. “The present results suggest, in line with international and KDIGO (Kidney Disease: Improving Global Outcomes) guidelines, that antiviral therapy should be systematically offered to HBV- and/or HCV-infected kidney transplant recipients or candidates to prevent the impact of chronic viral replication.

“Antiviral therapy with nucleos(t)ide analogues or direct antiviral agents should systematically be proposed, considering the major impact on patient and graft survival.”

Fonatine H, Alric L, Labreuche J et al. Control of replication of hepatitis B and C virus improves patient and graft survival in kidney transplantation. Journal of Hepatology 14 March 2019.

http://dx.doi.org/10.1016/j.jhep.2018.12.036

Tags: Europe | Flu & Viruses | Internal Medicine | Pharmaceuticals | Transplant

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