Treatment of Hepatitis C Virus Infection and Drug Interactions After Kidney Transplantation; Case Presentation and Review of the Literature

Abstract

New direct acting antiviral agents are quite effective in treating hepatitis-C virus infection (HCV).

Treating HCV that occurs or relapses after kidney transplantation necessitates a heedful approach for

selecting the proper antiviral alternatives with respect to possible drug interactions. Here we want to lay

emphasis on drug interactions in kidney transplant recipients along with a case that developed calcineurin

inhibitor toxicity after initiation of anti-HCV treatment. A 48-year-old male was admitted after acute

severe toxicity with tacrolimus due to a drug interaction with an antiviral regimen including ritonavir

for relapsing genotype-1b HCV infection. Cessation of tacrolimus and antiviral therapy provided

recovery. Sustained viral response was achieved with the same antiviral regimen with conversion to

very low dose cyclosporine-A (CsA). Selection of a proper anti-HCV treatment combination for kidney

transplant recipients requires consideration of the viral genotype, clinical features and possible drug

interactions with immunosuppressives. These patients must therefore be followed by a hepatologist as

well as a nephrologist.