Elbasvir/Grazoprevir Use in Postliver Transplantation Patients on Hemodialysis.

Background: Current national hepatitis C virus (HCV) guidelines do not recommend the use of elbasvir/grazoprevir (EBR/GZR) in postliver transplantation (LT) patients due to drug-drug interactions (DDIs) with immunosuppression agents. However, recommendations do not address the treatment of HCV in renally-impaired post-LT patients. Treatment regimens that are recommended for post-LT patients are not safe in patients with severe renal impairment and patients on dialysis. EBR/GZR is approved for use in patients with renal impairment and patients on dialysis, but not in the post-LT setting. Methods: Authors reviewed the electronic medical records of 3 treatment-naive HCV GT 1a male post-LT patients on hemodialysis who were treated with EBR/GZR with or without ribavirin for 12 or 16 weeks. Results: No patients had serious adverse drug events during treatment and no patients stopped treatment early or died. Providers monitored immunosuppression levels; both patients who were taking tacrolimus required immunosuppression dose adjustments during HCV treatment. No patients experienced organ rejection. All patients achieved sustained virologic response. Conclusions: Current HCV guidelines do not address the treatment options for post-LT patients with severe renal impairment or who are on dialysis, nor do published accounts of use of EBR/GZR in this patient population exist. Clinicians may benefit from exposure to real-world cases of HCV treatment in this historically difficult-to-cure patient population. Providers must address DDIs with EBR/GZR and monitor for changes in immunosuppression levels to ensure safety with its use in post-LT patients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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