# Prophylactic Treatment of Hepatitis C Virus Infection After Kidney Transplantation with the Combination of Glecaprevir/Pibrentasvir and Sofosbuvir in a Highly Sensitized Hepatitis C Virus-Negative Recipient: A Case Report and Review of the Literature

## TL;DR

A kidney transplant from an HCV-positive donor to a highly sensitized HCV-negative recipient was successful using DAA treatment before and after surgery.

## Contribution

This case report demonstrates the successful use of DAA prophylaxis and treatment in a highly sensitized HCV-negative kidney transplant recipient.

## Key findings

- DAA treatment with glecaprevir/pibrentasvir before transplantation prevented HCV infection in a highly sensitized recipient.
- Post-transplant triple DAA therapy achieved undetectable HCV viral load at 12 and 24 weeks.
- The kidney allograft functioned well with no major complications at 19 months post-transplant.

## Abstract

Background: Since the discovery of successful direct-acting antiviral (DAA) treatment, kidneys from hepatitis C virus (HCV) RNA-positive donors represent a new opportunity to expand the organ donor pool for HCV-negative recipients. Case presentation: In this paper, we describe a unique case of transplantation of an HCV genotype 3a-infected kidney into an HCV-negative recipient who was highly sensitized, with a virtual panel-reactive antibody level of 99.96%. Prior to the kidney transplantation, the recipient received DAA treatment with glecaprevir/pibrentasvir as a viable prophylactic strategy. Post-transplant, the recipient received a triple-combination DAA regimen with glecaprevir/pibrentasvir/sofosbuvir, which continued for 12 weeks. Subsequently, viral load was undetectable at 12 and 24 weeks after treatment, with no significant adverse events associated with DAA therapy. A 12-month post-transplantation biopsy revealed mixed rejection requiring treatment. The 19-month follow-up showed a favorable outcome regarding the function of the kidney allograft and the recipient’s quality of life. HCV-positive transplantation allowed our recipient to receive a kidney from an immunologically compatible donor without donor-specific antibodies and the need for desensitization strategies. Conclusions: Each transplant center should decide on the selection of candidates for kidney transplantation from HCV RNA-positive donors to HCV-negative recipients, the availability and choice of DAA treatment, and post-transplant follow-up. Our case emphasizes the need for early DAA treatment based on viral load and HCV genotyping, as well as for careful post-transplant surveillance including protocol biopsies.