Compare the viral load of hepatitis c virus in patients converted to certican versus patients who are maintained on calcineurin inhibitor.
The infection by hepatitis C virus (HCV) is the leading cause of chronic liver disease in renal transplant recipients. The prevalence of pretransplantation anti-HCV is 11% to 49%. The impact of HCV infection on patient survival after renal transplant remains controversial. Some studies also showed that patients undergoing renal transplantation anti-HCV positive are associated with a reduction in graft and patient survival.Chronic infection of HCV is associated with an increased number of infections. In HCV positive renal transplant patients have been shown that there is an increase from four to seven times in HCV viremia after transplantation compared to pretransplant. To prevent viral replication, immunosuppression must be adapted, involving a balance between control of viral replication and rejection. Biochemically, the NS5A protein has been linked to increased replication of the hepatitis C virus through p70S6K phosphopeptides. Sirolimus as inhibitor of pathway mTOR/p70S6K reduced in vivo phosphorylation of NS5A phosphopeptides and thus viral replication. Moreover, the mTOR protein has been proven in vitron to have a protective role against apoptosis in HCV infected cells (WAGNER et al., 2010). Wagner et al. (2010) showed a beneficial effect of sirolimus on viral recurrence monitored by transaminases and viral load as well as by histological data. They also reported the improved survival after liver transplantation due to hepatitis C for patients receiving sirolimus rather than calcineurin inhibitor-based regimens. In the literature there have already been reported good virological control of HCV among liver transplant recipients after conversion to SRL and the reduction of hepatitis C virus recurrence (GALLEGO et al., 2009; BENEDETTOET al., 2010). Everolimus has shown a potent inhibitor of mTOR and has been widely used as an immunosuppressive agent in kidney transplant, but no reported effects on HCV progression was found in the literature.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
30
The conversion will be performed abruptly for all patients. Calcineurin inhibitor will be discontinued one day before the day of conversion (Day 1). Everolimus will be introduced on day 1 at dose of 3 mg/d (1,5mg bid), and then everolimus trough levels will be adjusted to achieve 6-10 ng/ml.
Trough level should be between 100 and 200ng/ml.
Trough level should be between 5 and 10ng/ml.
Irmandade Da Santa Casa de Misericórdia de Porto Alegre
Porto Alegre, Rio Grande do Sul, Brazil
Change from baseline in viral load of hepatitis C virus at 12 months after randomization.
HCV viremia will be measured by polymerase chain reaction (PCR)
Time frame: Baseline,Months 3, 6, 9 and 12 after randomization
Incidence of acute allograft rejection
All patients will perform at least 07 protocol visits and should be performed renal biopsy during screening phase and during the follow up if present renal dysfunction or proteinuria.
Time frame: Weeks 1, 2, 3, months 1, 3, 6, 9 and 12 after randomization
Incidence of significant infections
During the study visits the patient will be evaluated by a doctor and it will perform blood tests to assess their clinical conditions.
Time frame: Weeks1, 2, 3 and months 1, 3, 6,9 and 12 after randomization
Development of proteinuria
Spot urine sample for protein and creatinine will be performed.
Time frame: Months 1, 3, 6, 9 and 12 after randomization
Development of malignance
Medical evaluation will be performed during the protocol visits and if necessary biopsy and exams of imaging to confirm any suspected.
Time frame: Weeks 1, 2, 3 and months 1, 3, 6, 9 and 12 after randomization
Development of dyslipidemia
Lipid levels: total cholesterol, HLD, LDL and triglycerides will be performed.
Time frame: Months 1, 3, 6, 9 and 12 after randomization
Development of liver impairment
Blood chemistry: TGO/AST, TGP/ALT , GGT and alkaline phosphatase will be performed.
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Time frame: Months 1, 3, 6, 9, and 12 after randomization
Development of post-transplant diabetes
Blood chemistry: Glucose will be performed.
Time frame: Months 1, 3, 6, 9 and 12
Development of hypertension
Vital signs will be performed
Time frame: Weeks 1, 2, 3 and months 1, 3, 6, 9 and 12 after randomization
Graft loss survival
Graft survival will be evaluated by our team doctor.
Time frame: Weeks 1, 2 , 3 and months 1, 3 ,6, 9 and 12 after randomization
Patient survival
Subject survival will be evaluated by our team doctor
Time frame: Weeks 1, 2, 3 and months 1, 3, 6, 9 and 12 after randomization