Hepatitis C Virus (HCV) Recurrence and Death After Viral Clearance in an HCV-Viremic Donor to HCV-Negative Kidney Recipient

Shengliang He; Tomohiro Tanaka; Sung-Hoon Kim; David Thomsen; Daniel A. Katz; Christie P. Thomas; Prerna Rastogi; Hassan Aziz; Alan I. Reed

doi:10.1016/j.xkme.2025.101139

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Hepatitis C Virus (HCV) Recurrence and Death After Viral Clearance in an HCV-Viremic Donor to HCV-Negative Kidney Recipient

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Hepatitis C Virus (HCV) Recurrence and Death After Viral Clearance in an HCV-Viremic Donor to HCV-Negative Kidney Recipient

Shengliang He, Tomohiro Tanaka, Sung-Hoon Kim, David Thomsen, Daniel A. Katz, Christie P. Thomas, Prerna Rastogi, Hassan Aziz and Alan I. Reed

Kidney medicine, Vol.7(12), 101139

12/2025

DOI: 10.1016/j.xkme.2025.101139

PMCID: PMC12666545

PMID: 41333095

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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 demise of the transplanted individual. A 52-year-old male, 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 following completion of DAA regimen. HCV recurrence should be considered with abnormal liver chemistries in the absence of alternative explanations.

Details

Title: Subtitle: Hepatitis C Virus (HCV) Recurrence and Death After Viral Clearance in an HCV-Viremic Donor to HCV-Negative Kidney Recipient
Creators: Shengliang He
Tomohiro Tanaka
Sung-Hoon Kim
David Thomsen
Daniel A. Katz
Christie P. Thomas
Prerna Rastogi
Hassan Aziz
Alan I. Reed
Resource Type: Journal article
Publication Details: Kidney medicine, Vol.7(12), 101139
DOI: 10.1016/j.xkme.2025.101139
PMID: 41333095
PMCID: PMC12666545
NLM abbreviation: Kidney Med
ISSN: 2590-0595
eISSN: 2590-0595
Publisher: Elsevier; AMSTERDAM
Language: English
Electronic publication date: 10/2025
Date published: 12/2025
Academic Unit: Health Management and Policy; Stead Family Department of Pediatrics; Gastroenterology and Hepatology; Pathology; Accounting; Surgery; Obstetrics and Gynecology; Nephrology; Internal Medicine
Record Identifier: 9985014804602771

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