Hepatitis C Treatment With Direct-Acting Antivirals in Kidney Transplant: Preliminary Results From a Multicenter Study.

Hepatitis C (HC) is a very relevant negative prognosis factor for graft and transplant recipient survival. New direct-acting antivirals (DAAs) allow us to solve this problem in an effective way. It is crucial to understand their real impact in our daily practice. We analyzed treatment results with DAA, free of interferon, in kidney transplant recipients (KTRs) from 15 Spanish hospitals (Grupo Español de Actualización en Trasplante), regarding effectiveness, tolerance, and impact on immunosuppression, renal function-proteinuria, and diabetes. One hundred nineteen KTRs were included (9 combined liver-kidney transplants). The main DAA used was sofobusvir (91%) combined with ledipasvir (55%), simeprevir (14%), or daclatasvir (13%); in 9 cases (7%), a paritaprevir-ritonavir-ombitasvir-dasabuvir combination (3D) was used; Ribavirin was used as a coadjuvant in 18%. Side effects were limited (23.5%) and without relevance in general, except in 7 patients for whom we needed to interrupt the treatment due to neurotoxicity (1) caused by drug interaction (3D and tacrolimus) or anemia (3) by Ribavirin or others. Ninety-four patients had completed the treatment when data were analyzed: virological response was seen in 97.8% % of cases. Liver function analysis improved: 84% normal versus 21% before starting the treatment (P < .001). Renal function and proteinuria did not change. Tacrolimus level at the end of DAA-treatment was significantly lower with respect to the beginning (5.8 ± 2.1 ng/mL vs. 7.4 ± 1.8 ng/mL, P = .03), despite a slight increase in the dose (2.6 mg/d vs. 2.3 mg/d, P = .17). DAA are highly effective in the treatment of hepatitis C in KTRs with good tolerance in general, making it possible to solve the problem and have a good chance to improve the prognosis in our transplantation patients. The use of these therapies in KTRs requires special control and coordination with digestive professionals, especially if 3D or Ribavirin is used.

[Thromboembolism prevention in acute myocardial infarction]. / Profilaxis tromboembólica en infarto agudo de miocardio.

The objectives were to identify risk factors for vein thromboembolic disease (VTD) among patients with acute myocardial infarction (AMI) and to analyse both quantitatively and qualitatively the performed thromboembolic prophylaxis. A cross-sectional study was carried out with all inpatients at the Coronary Unit at our hospital during 1998. The risk factors for thromboembolism included: inmobilization (79.2%), heart failure (33.2%) and age over 70 years (31%). VTD prophylaxis was performed in 86.9% of the time. Non-fractioned heparin (NFH) and low molecular weight heparins (LMWH), mostly nadroparine, were the most commonly used drugs at admission and at discharge, respectively. Overdosage and underdosage for NFH and LMWH, respectively, were observed. That patients received or not VTD prophylaxis was not influenced by thromboembolic risk factors.

Profilaxis tromboembólica en infarto agudo de miocardio / Thromboembolic prophylaxis in acute myocardial infarction

Los objetivos eran identificar los factores de riesgo de enfermedad tromboembólica venosa (ETV) en los pacientes con infarto agudo de miocardio (IAM) y analizar cuantitativa y cualitativamente la profilaxis tromboembólica realizada. Se ha hecho un estudio transversal de todos los pacientes ingresados en la Unidad Coronaria de nuestro hospital durante 1998. Los factores de riesgo tromboembólico han sido: inmovilización (79,2 por ciento), insuficiencia cardíaca (33,2 por ciento) y edad superior a 70 años (31 por ciento). Se hizo profilaxis de ETV en el 86,9 por ciento. La heparina no fraccionada (HNF) fue el fármaco más utilizado durante el ingreso y las heparinas de bajo peso molecular (HBPM) al alta, mayoritariamente nadroparina. Existía sobredosificación para las HNF e infradosificación para las HBPM. Los factores de riesgo tromboembólico no influyeron en que los pacientes recibieran o no profilaxis de ETV (AU)