Table 1.

HCV treatment—pre and post transplant approach

Renal impairment	Treatment/dose	Comments
Mild CrCl-50-80 ml/mt	Peg IFN+ RBV/no dose adjustment required
Moderate CrCl-30–50 ml/mt	Standard dose of DAA/PegIFNα2a daclatasvir, ledipasvir–sofosbuvir, ombitasvir–paritaprevir–ritonavir, ombitasvir–paritaprevir–ritonavir plus dasabuvir, simeprevir, sofosbuvir, orpeginterferon alfa-2a	PegIFNα-2b should be reduced by 25% (1.125 mcg/kg once weekly) RBV-200 mg alternating with 400 mg
Severe/ESRD CrCl-<30 ml/mt	IFN monotherapy Dual therapy-PegIFN+RBV (low dose)	Based on the genotype RBV should be discontinued if Hb decreased v by 2 gm/dl despite using erythropoitin
Post transplant	Peg IFN—contraindicated Unless-worsening of liver damage IFN-associated with graft rejection	Good recovery of renal function after Tx Use of new DAA agents may provide excellent interferon-free treatment options

Guide lines of the American Association for the study of liver diseases and the infectious diseases society of America (AASLD/IDSA)

CrCl creatinine clearance, DAA direct acting antiviral, ESRD end stage renal disease, Hb hemoglobin, RBV ribavirin, IFN interferon