S3511 Management of Complications After Liver Transplantation for Hepatitis C Negative Patients Receiving Hepatitis C Positive Organs

Abstract

INTRODUCTION: More than 16,000 patients are awaiting a liver transplant with less than 6,700 successful liver transplants in the U.S. that occur each year. Using a hepatitis C virus (HCV) positive donor liver for transplantation increases the donor pool. When HCV negative patients receive an HCV positive liver, they are at risk of acquiring HCV infection. We report two cases of patients who were HCV negative and received HCV positive donor liver subsequently acquiring HCV infection and developing associated complications. CASE DESCRIPTION/METHODS: The first patient is a 71 year old male with a history of non-alcoholic steatohepatitis (NASH) cirrhosis, hepatocellular carcinoma, and hepatic encephalopathy. He developed HCV infection status-post orthotopic liver transplantation from HCV donor. Imaging before transplant and explant pathology showed hepatocellular carcinoma. He was found to have HCV genotype 2B infection 2 weeks post-transplant as part of protocol testing. He was treated with sofosbuvir/velpatasvir for 12 weeks and achieved sustained viral response (SVR). Imaging at 5 months post-op revealed 2 hypovascular masses diagnosed as epstein barr virus associated B-cell post-transplant lymphoproliferative disorder (PTLD). Treatment was initiated with rituximab and his hospital course was complicated by bacteremia and atrial fibrillation. The second patient is a 52 year old male with NASH cirrhosis status-post orthotopic HCV positive liver transplant. His post-transplant course was complicated by elevated liver enzymes and renal insufficiency. He was found to have HCV genotype 1a, 3 months after transplant, and was treated with sofosbuvir/velpatasvir for 12 weeks with achieving SVR. Liver tests subsequently returned to normal with treatment. DISCUSSION: Although using HCV positive donor liver increases the donor pool it is associated with increased risk of HCV transmission to the recipient. These recipients need to be closely monitored so they could be treated in a timely manner to prevent any associated complications.Figure 1.: CT scan showing two hypovascular hepatic masses in the right and left lobes, measuring up to 3 cm.