B Balaji Kirushnan
Miot International, India
Title: Novel therapies for hepatitis C in dialysis and kidney transplant recipients
Biography
Biography: B Balaji Kirushnan
Abstract
Chronic hepatitis C remains an important health problem in chronic kidney disease and is associated with reduced graft survival after renal transplantation. It is more common in developing countries and in haemodialysis centers, where there is a break in universal precautions during reuse of haemodialyzers. Hepatitis C is also associated with increased rates of rejection, new onset diabetes mellitus and occurrence of de-novo glomerulonephritis after renal transplant. It is associated with fibrosing cholestatic hepatitis and extra hepatic complications like vasculitis. The recommended treatment in the post-transplant setting with interferon is only when the benefits of the treatment outweigh the risks. Conventional interferon therapy in the post renal transplant scenario has been associated with increased rates of allograft rejection. Directly acting antivirals (DAA) could offer a new therapeutic armamentarium in post renal transplant recipients without precipitating rejection. Newer drugs like sofosbuvir, ledipasvir and daclatasvir have been used in hemodialysis and peritoneal dialysis patients to achieve a sustained virological response before renal transplant. The above strategy has shown better outcome in terms of patient tolerability of drugs and sustained remission rates of virological response after transplant.