ArticleKidney medicine2025
Hepatitis C Virus (HCV) Recurrence and Death After Viral Clearance in an HCV-Viremic Donor to HCV-Negative Kidney Recipient.
Article in Kidney medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
Current direct-acting antiviral (DAA) regimens have achieved nearly universal viral eradication in hepatitis C virus (HCV) nucleic acid test (NAT)-positive donor to HCV-negative recipient (HCV NAT+/-) transplantation. This case study presents an early HCV recurrence after initial viral clearance with DAA therapy in an HCV NAT+/- kidney recipient that then rapidly progressed to acute liver failure and the death of the transplanted individual. A 52-year-old man with type 2 diabetes underwent a deceased donor HCV NAT+/- kidney transplant. Postoperatively, the allograft function gradually improved without necessitating dialysis. HCV NAT at postoperative day (POD) #3 revealed a viral load of 5 log IU/mL. A 12-week course of sofosbuvir/velpatasvir was completed, and HCV NAT was negative by POD#94. His liver enzymes were significantly elevated at POD#170. Repeat HCV NAT showed viral load at >8 log IU/mL. Sofosbuvir/velpatasvir was reinitiated with a plan to transition to sofosbuvir/velpatasvir/voxilaprevir. On POD#183, the patient was admitted for diabetic ketoacidosis and acute liver failure. His condition rapidly deteriorated to multi-organ failure, and he died on POD#188. Fatal recurrence is rare in HCV NAT+/- kidney transplant recipients after completion of DAA regimen. HCV recurrence should be considered with abnormal liver chemistries in the absence of alternative explanations.
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