Hepatitis C Virus Eradication in Kidney Transplant Recipients: A Single-Center Experience in Portugal A. Weigert a, *, S. Querido a , L. Carvalho b , L. Lebre b , C. Chagas b , P. Matias a , R. Birne a , C. Nascimento a , C. Jorge a , T. Adragão a , M. Bruges a , and D. Machado a a Nephrology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; and b Gastroenterology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal ABSTRACT Introduction. Hepatitis C (HCV) is a major cause of liver impairment postekidney trans- plantation (KT). Anti-HCV direct-acting antivirals (DAA) made viral eradication possible. Methods. We performed a retrospective review of KT patients (n ¼ 23) who received DAA at our hospital. Sustained viral response (SVR) was defined as absence of viral detection 12 weeks after cessation of therapy. Results. From 1985 to September 2017, 1440 patients underwent transplantation at Hospital Santa Cruz. From a total of 32 HCV RNAþ KT recipients on follow-up, we describe the first 23 patients treated with DAA. They were 56.7 Æ 9.1 years old; 22 were white, 52.2% were males, they underwent transplantation 18.8 Æ 9.0 years ago, and 13 had genotype 1B, 21 were naïve, and 9 had stages F3/F4. All but 2 patients, treated with grazoprevir/elbasvir, received sofosbuvir (18 with ledispasvir, 2 with daclastavir, and 4 with simultaneous ribavirin). Pretreatment, intra-treatment, and post-treatment creatinine clearances were 61.4, 60.6, and 60.7 mL/min/1.73 m 2 , respectively (not significant [NS]). Cyclosporine A was the basis of immunosuppression in the majority [(n ¼ 14); pretreatment and intra- treatment levels were 79.5 Æ 23.0 and 91.8 Æ 26.0 ng/mL, respectively (P ¼ .08)]; tacrolimus (n ¼ 8) and mammalian target of rapamycin (mTOR) levels (n ¼ 5) were also similar. One patient interrupted ribavirin after 7 weeks due to anemia; all other patients completed the treatment course without major side effects. Only 3 patients presented positive viral RNA at the fourth week of treatment and SVR was achieved in 100% of the patients 12 weeks after treatment. Conclusions. DAA therapy was well tolerated and effective in 100% of our treated patients, without significant impact on the renal function or on the immunosuppression. A LTHOUGH the prevalence of hepatitis C virus (HCV) infection has been decreasing both in hemodialysis patients and in recipients of kidney allografts, it is still a significant problem in both populations. With the introduc- tion of direct-acting antivirals (DAA) against HCV, viral eradication in both groups of patients became possible. The prevalence of HCV has been decreasing; it is currently pre- sent in 3.4% of hemodialysis patients and 2.2% of peritoneal dialysis patients in our country [1]. However, this prevalence was much higher in past decades when HCV antibody eval- uation was impossible (many patients were then labeled as having “nonA, nonB hepatitis”) and erythropoietin was not available, reasons for an extensive use of unscreened blood transfusions. Fortunately this reality changed many years ago, but a large burden of HCV-seropositive patients was left from this period. Interferon and ribavirin-based treatments were not only poorly tolerated and frequently ineffective, they also had the potential to trigger rejection and severe anemia. Therefore, these treatments were only used in kidney *Address correspondence to André Weigert, MD, PhD, Nephrology, Hospital de Santa Cruz, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, Portugal. E-mail: alweigert@gmail.com ª 2018 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169 0041-1345/18 https://doi.org/10.1016/j.transproceed.2018.02.017 Transplantation Proceedings, 50, 743e745 (2018) 743