Impact of sustained viral response with direct-acting agents on glycemic control and renal function in hepatitis c liver transplant recipients

Objectives: The impact of achieving a sustained viral response on extrahepatic manifestations after liver transplant is unclear. In this study, our aim was to evaluate whether sustained viral responses in hepatitis C-positive liver transplant recipients can lead to improved nonhepatic outcomes. Materials and Methods: We studied 84 consecutive liver transplant recipients who achieved a sustained viral response with direct-acting antiviral agents at the University of California Los Angeles. We collected laboratory data before and after the sustained viral response was achieved. Paired t tests were performed. Results: The mean age and standard deviation of our cohort was 62.4 ± 7.6 years. The mean time from achieving a sustained viral response to last follow-up in our cohort was 19.5 ± 10.8 months. In the entire cohort, there were no changes in mean fasting blood glucose (123 ± 42 vs 120 ± 35 mg/dL; P =.49). We observed a significant improvement in renal function in recipients with stage 1 and 2 chronic kidney disease (82 ± 15 vs 71.16 ± 16 mL/min/1.73 m2; P <.001) and in those treated within 3 months of liver transplant (75 ± 28 vs 61 ± 16 mL/min/1.73 m2; P =.035). Fasting blood glucose decreased in recipients with a diagnosis of impaired fasting blood glucose (109 ± 16 vs 103 ± 13 mg/dL; P =.001). Conclusions: The benefits on glucose metabolism and renal function after a sustained viral response in liver transplant recipients appear to be limited to those with early chronic kidney disease and those treated soon after transplant. The potential benefits from direct-acting antiviral agents on these parameters may be overshadowed by the effects of immuno - suppressant therapy.