Hepatitis C–associated focal proliferative glomerulonephritis in an aviremic recipient of a hepatitis C–positive antibody donor liver

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. After transplantation of a liver from an HCV Ab+/NAT– donor, a recipient who was aviremic prior to transplantation exhibits viremia early after transplant and develops focal proliferative glomerulonephritis that was successfully treated with pan‐genotypic direct‐acting antivirals.