The Effect of Anti-Viral Treatment of HCV Infection on Outcomes of Renal Transplant Patients with Chronic HCV Infection: A Real-World Cohort Study

<b>Background/Objectives:</b> Chronic hepatitis C virus (HCV) infection remains a significant comorbidity in patients with end-stage renal disease (ESRD), complicating outcomes after kidney transplantation. The anti-viral treatment of HCV infection including Direct-acting antivirals (DAAs) have transformed HCV treatment, but evidence remains limited. <b>Methods:</b> We conducted a retrospective, real-world cohort study using the TriNetX Analytics Network. Patients were divided into two cohorts: those who received anti-viral treatment of HCV infections before transplant (n = 982) and those who did not (n = 982), following 1:1 propensity score matching. <b>Results:</b> Outcomes assessed one year post-index included mortality, hepatic complications, graft failure, and serum creatinine >6 mg/dL. Anti-HCV infection treated patients had significantly lower risks of graft failure (aHR: 0.656; 95% CI: 0.434, 0.993; <i>p</i> < 0.001) and severe renal dysfunction (aHR: 0.619; 95% CI: 0. 0.390, 0.984; <i>p</i> < 0.001) compared to untreated patients. While mortality (aHR: 0.901; 95% CI: 0.728, 1.114) and liver-related outcomes trended favorably in the treated group, they did not reach statistical significance. <b>Conclusions:</b> Our findings demonstrate that pre-transplant anti-viral treatment of HCV infection in HCV-infected kidney transplant recipients is associated with improved graft survival and renal function.