Successful Kidney Transplantation in a Recipient Coinfected with Hepatitis C Genotype 2 and HIV from a Donor Infected with Hepatitis C Genotype 1 in the Direct-Acting Antiviral Era

Abstract

Despite significant advances in transplantation of HIV-infected individuals, little is known about HIV coinfected patients with hepatitis C virus (HCV) genotypes other than genotype 1, especially when receiving HCV-infected organs with a different genotype. We describe the first case of kidney transplantation in a man coinfected with hepatitis C and HIV in our state. To our knowledge, this is also the first report of an HIV/HCV/HBV tri-infected patient with non-1 (2a) HCV genotype who received an HCV-infected kidney graft with the discordant genotype (1a), to which he converted after transplant. Our case study highlights the following: (1) transplant centers need to monitor wait times for an HCV-infected organ and regularly assess the risk of delaying HCV antiviral treatment for HCV-infected transplant candidates in anticipation of the transplant from an HCV-infected donor; (2) closer monitoring of tacrolimus levels during the early phases of anti-HCV protease inhibitor introduction and discontinuation may be indicated; (3) donor genotype transmission can occur; (4) HIV/HCV coinfected transplant candidates require a holistic approach with emphasis on the cardiovascular risk profile and low threshold for cardiac catheterization as part of their pretransplant evaluation.

Expanding Access to Organ Transplant for People Living With HIV: Can Policy Catch Up to Outcomes Data?

“…68 A single report of successful kidney transplantation from an HCV genotype 1a donor into a recipient with HIV and HCV genotype 2a, and subsequent clearance of HCV by treatment with DAAs, illustrates the feasibility of this approach and the advantage of reduced waiting time for transplant. 69 A simulation comparing the 2 strategies, pretransplant versus posttransplant treatment, concluded that treatment posttransplant was consistently cost-saving because of the high cost of dialysis. 70 Among patients with low fibrosis liver disease (F0-F1), treatment posttransplant also yielded higher life months and quality-adjusted life months, except among F1 candidates with wait times ≥18 mo.…”