N AGARWAL1, R DAVIS 2, J WONG 3, S STRASSER4, K KABLE5, G WONG5, B NANKIVELL5, K WYBURN 1,6
1Renal Department of Royal Prince Alfred Hospital, Camperdown, NSW; 2Department of Infectious Disease and Microbiology, Royal Prince Alfred Hospital, Camperdown, NSW; 3Renal Department of Liverpool Hospital, Liverpool, NSW; 4AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW; 5Renal Department of Westmead Hospital, Westmead, NSW; 6University of Sydney, Sydney, NSW.
Background: The introduction of Direct Acting Anti-viral (DAA) treatment for Hepatitis C virus (HCV) has led to the potential to transplant organs from donors previously treated for HCV into HCV negative recipients.
Case report: We report a case of two kidney recipients who were HCV negative at the time of transplant. Both received a transplant from a 55 year old deceased donor with a past history of Hepatitis C who was treated for 12 weeks with ledipasvir/sofosbuvir and achieved a sustained viral response (SVR). At the time of organ retrieval, the donor was HCV antibody (anti-HCV) positive but negative for HCV RNA by nucleic acid testing (NAT). Both kidney recipients on routine screening had newly detected anti-HCV at Day 31 (left kidney recipient) and Day 99 (right kidney recipient) post transplant, but they remained HCV RNA negative. At 6 months post transplant both have normal liver function, excellent graft function (creatinine 130umol/l and 135umol/L respectively), with no episodes of rejection nor proteinuria, and they remain anti-HCV positive and HCV RNA negative. Neither kidney recipient had high-risk behaviours or healthcare exposures such as blood products to suggest an alternative source of transmission. The lungs were transplanted into an anti-HCV positive, HCV RNA negative recipient who has remained HCV RNA negative post transplant.
Conclusions: To our knowledge, this is the first description of HCV antibody detection in kidney recipients who received an organ from an anti-HCV positive donor who had successful treatment with a DAA. As there is no evidence to suggest HCV infection of the recipients, we hypothesise that these HCV antibodies are derived from donor passenger leucocytes.