Section of Transplant Surgery, Ochsner Health, New Orleans, Louisiana.
Ochsner Clinical Medical School, Queensland Medical School, New Orleans, Louisiana.
Am J Transplant. 2021 Aug;21(8):2895-2899. doi: 10.1111/ajt.16565. Epub 2021 May 4.
Shortage of organs for liver transplantation (LT) and the availability of highly efficient pan-genotypic direct-acting antivirals (DAAs) against hepatitis C virus (HCV) have allowed the use of livers from HCV-positive antibody/negative nucleic acid test donors (dHCV Ab+/NAT-) into aviremic HCV recipients over the last few years. We report the case of a patient who received an LT from an HCV Ab+/NAT- donor and, after HCV viremic conversion, developed a nephrotic syndrome due to a focal proliferative glomerulonephritis early after LT. Patient's renal function and proteinuria resolved after successful treatment with DAAs. Renal and hepatic function remain normal over 24 months of follow-up. This case restates the success of LT using livers from dHCV Ab+/NAT- in aviremic recipients in the context of DAAs while illustrating the risk for potential complications associated with the HCV transmission and reinforcing the importance of early initiation of anti-HCV therapy.
近年来，由于肝移植（LT）器官短缺和针对丙型肝炎病毒（HCV）的高效泛基因型直接作用抗病毒药物（DAA）的出现，允许将 HCV 阳性抗体/阴性核酸检测供体（dHCV Ab+/NAT-）的肝脏用于 HCV 血症受者。我们报告了一名患者的病例，该患者接受了来自 HCV Ab+/NAT-供体的 LT，在 HCV 病毒血症转换后，在 LT 后早期因局灶性增生性肾小球肾炎而发生肾病综合征。患者的肾功能和蛋白尿在 DAA 成功治疗后得到缓解。在 24 个月的随访中，肾脏和肝功能均保持正常。该病例再次证明了在 DAA 背景下，将 dHCV Ab+/NAT-供体的肝脏用于 HCV 血症受者的 LT 取得了成功，同时说明了与 HCV 传播相关的潜在并发症的风险，并强调了早期开始抗 HCV 治疗的重要性。
