Abstract

The advent of highly effective and well-tolerated direct-acting antiviral (DAA) therapy has made it more feasible to transplant HCV virus-infected organs into HCV-negative recipients. This case report presents the outcomes of four patients who underwent multi-visceral transplantation (MVT) from HCV NAT-viremic donors, with one recipient also requiring a kidney transplant. All recipients received post-transplant direct-acting antiviral (DAA) therapy with sofosbuvir/velpatasvir (SOF/VEL-Epclusa). By the fourth week of therapy, none of the recipients exhibited detectable viral loads, and all achieved sustained virologic response at 12 weeks (SVR-12). Allograft function for HCV D+/R- recipients remained excellent throughout follow-up. One recipient died from post-transplant lymphoproliferative disorder (PTLD) and another developed end-stage renal disease (ESRD); both outcomes were ostensibly unrelated to HCV-donor status. The other two patients are progressing well without any evidence of allograft rejection.