Direct-acting antiviral agent-based regimen for HCV recurrence after combined liver-kidney transplantation: Results from the ANRS CO23 CUPILT study

Sébastien Dharancy (1) , Audrey Coilly (2, 3) , Claire Fougerou-Leurent (4, 5) , Christophe Duvoux (6) , Nassim Kamar (7, 8) , Vincent Leroy (9) , Albert Tran (10) , Pauline Houssel-Debry (5) , Valérie Canva (11) , Christophe Moreno (12) , Filoména Conti , Jérome Dumortier (13, 14) , Vincent Di Martino (15) , Sylvie Radenne (16) , Victor de Ledinghen (17) , Louis d'Alteroche (18) , Christine Silvain (19) , Camille Besch , Philippe Perré , Danielle Botta-Fridlund (20) , Claire Francoz (21) , François Habersetzer (22) , Hélène Montialoux , Armand Abergel (23) , Maryline Debette-Gratien (24, 25) , Alexandra Rohel (26) , Emilie Rossignol (4) , Didier Samuel (2, 3) , Jean-Charles Duclos-Vallée (2, 3) , Georges-Philippe Pageaux (27, 28)

1 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
2 Hôpital Paul Brousse
3 Physiopathologie et traitement des maladies du foie
4 CIC - Centre d'Investigation Clinique [Rennes]
5 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
6 Service d'Hépatologie, Hôpital Henri Mondor, AP-HP, Créteil, France.
7 I2MR - Institut de médecine moléculaire de Rangueil
8 CPTP - Centre de Physiopathologie Toulouse Purpan
9 Département de Gastroentérologie et hépatologie
10 C3M - Centre méditerranéen de médecine moléculaire
11 Service d'hépato-gastro-entérologie
12 ULB - Hôpital Erasme [Bruxelles]
13 Hôpital Edouard Herriot [CHU - HCL]
14 Département d'hépatologie
15 Service d'hépatologie
16 Hôpital de la Croix-Rousse [CHU - HCL]
17 Physiopathologie du cancer du foie
18 CHU Trousseau [Tours]
19 Hôpital de la Milétrie
20 Chirurgie Digestive
21 Service d'hépatologie
22 IVH - Institut de Recherche sur les Maladies Virales et Hépatiques
23 Chirurgie digestive et hépatobiliaire
24 PIST - Pharmacologie des Immunosuppresseurs et de la Transplantation
25 Service d'Hépato-gastro-entérologie et Nutrition [CHU Dupuytren 1, Limoges]
26 ANRS France Recherche Nord & sud Sida-hiv hépatites
27 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
28 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)

Hepatitis C virus (HCV) infection is associated with reduced patient survival following combined liver-kidney transplantation (LKT). The aim of this study was to assess the efficacy and safety of second-generation direct-acting antivirals (DAAs) in this difficult-to-treat population. The ANRS CO23 "Compassionate use of Protease Inhibitors in Viral C Liver Transplantation" (CUPILT) study is a prospective cohort including transplant recipients with recurrent HCV infection treated with DAAs. The present work focused on recipients with recurrent infection following LKT. The study population included 23 patients. All patients received at least one NS5B inhibitor (sofosbuvir) in their antiviral regimen an average of 90 months after LKT. Ninety-six percent of recipients achieved a sustained virological response (SVR) at week 12 (SVR12). In terms of tolerance, 39% of recipients presented with at least one serious adverse event. None of the patients experienced acute rejection during therapy and there were no deaths during follow-up. The glomerular filtration rate (GFR) decreased significantly from baseline to the end of therapy. However, this study did not show that the decline in GFR persisted over time or that it was directly related to DAAs. The DAA-based regimen is well tolerated with excellent results in terms of efficacy. It will become the gold standard for the treatment of recurrent HCV following LKT.

Mots clés: liver transplantation/hepatology; kidney transplantation/nephrology; liver disease: infectious; infectious disease; kidney failure/injury; infection and infectious agents - viral: hepatitis C; clinical research/practice

Domaines: Sciences du Vivant [q-bio]; Microbiologie et Parasitologie

Sébastien Dharancy, Audrey Coilly, Claire Fougerou-Leurent, Christophe Duvoux, Nassim Kamar, et al.. Direct-acting antiviral agent-based regimen for HCV recurrence after combined liver-kidney transplantation: Results from the ANRS CO23 CUPILT study. American Journal of Transplantation, 2017, 17 (11), pp.2869-2878. ⟨10.1111/ajt.14490⟩. ⟨hal-01640061⟩