Kidney transplantation from an anti-hepatitis C virus antibody-positive donor into an anti-hepatitis C virus antibody-negative recipient: A case report

Abstract Patients who test positive for hepatitis C virus (HCV) antibody are not considered suitable living kidney donor candidates for HCV negative recipients. Here, we report a case of an HCV positive patient treated successfully with antiviral therapy, achieving sustained virologic response (SVR), who subsequently donated a kidney to an HCV negative recipient without viral transmission. This suggests that HCV positive patients who achieve SVR may safely donate kidneys. A 66-year-old male with end-stage renal disease had been on hemodialysis for 7 years. His 63-year-old wife was a candidate for living donation, but had a history of HCV infection. She had received interferon-beta treatment 12 years previously. After the treatment, SVR was achieved and her liver enzymes were normalized. The recipient received a preconditioning regimen comprising a single dose of rituximab combined with cyclosporine microemulsion and mycophenolate mofetil 2 weeks before the transplantation for the desensitization of anti-blood type antibody. The operation was performed with no adverse events. Protocol kidney biopsies at 3 and 12 months showed no signs of rejection. The recipient's liver function tests remained within the normal range, HCV antibody testing was negative, and HCV RNA was undetectable at the 1-year follow-up. At the time of this writing, the recipient is healthy with a serum creatinine level of 1.2 mg/dL. Likewise, the donor is healthy with follow up indicating SVR, normal liver enzymes, and normal renal function. In conclusion, only in selected cases, HCV antibody positive donors may be taken into consideration as a kidney donor.