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

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.