Impact of anti‐HCV direct antiviral agents on graft function and immunosuppressive drug levels in kidney transplant recipients: a call to attention in the mid‐term follow‐up in a single‐center cohort study

Summary The medium‐term impact on graft function and immunosuppressive drug pharmacokinetics of direct antiviral agents (DAAs) among hepatitis C virus (HCV)‐infected kidney transplant (KT) recipients remain unclear. We compared pre‐ and post‐treatment 12‐month trajectories of estimated glomerular filtration rate (ΔeGFR) and 24‐h proteinuria (Δ24‐h proteinuria) in 49 recipients treated with DAAs (mostly sofosbuvir plus ledipasvir). Among evaluable patients, 66.7% and 100.0% had undetectable viral load by week 4 and end of therapy (EoT). The sustained virologic response rate at 12 weeks was 95.8%. Overall, 80.6% of patients receiving tacrolimus required dose escalation while on DAA‐based therapy (median increase of 66.7%) to maintain target levels. Tacrolimus levels resulted to be higher at 12 months compared to EoT (7.8 ± 2.1 vs. 6.7 ± 2.0 ng/ml; P‐value = 0.002). No changes in graft function during the course of therapy were observed. However, eGFR significantly decreased (P‐value