*Purpose: Due to a shortage of deceased donor kidney organs, increased waiting times have been associated with adverse outcomes post kidney transplantation. The recent breakthrough of HCV treatment with direct-acting antivirals has changed transplant practice worldwide by allowing the use of HCV+ deceased donor organs into HCV- recipients. Here we describe a case of successful kidney transplant with an HCV NAT+ deceased donor into an HIV positive recipient with the previous history of treated hepatitis C.

*Methods: Case Summary: The patient is a 54 year of African American male with a history of ESRD secondary to biopsy-proven HIV nephropathy. He has been on hemodialysis for 8 years and his HIV has been successfully treated with undetectable viral load and CD4 counts >200 consistently. He has a history of hepatitis C (genotype 1A) treated with glecaprevir/pibrentasvir x 12 weeks with negative RNA in 2018. He underwent deceased donor kidney transplantation from an HCV NAT+ donor (genotype 2) in March 2019. He received basiliximab and methylprednisone induction immunosuppression followed by tacrolimus, mycophenolate mofetil, and prednisone for maintenance. He had immediate graft function with nadir serum creatinine to 1.4 mg/dl followed by stable kidney function over the 8 months of follow up. His HCV RNA quantitative 12 days after transplant was 338,370 IU/ml. He was treated with elbasvir and grazoprevir x 12 weeks starting 6 weeks after transplantation with sustained viral response. His HIV viral load remains undetectable on current antiretroviral therapy.

*Results: .

*Conclusions: To our knowledge, this is one of the first reported cases of using an HCV NAT+ deceased donor kidney into an HIV+ recipient. Recently conducted pilot studies show that the use of HCV NAT+ donor kidneys in uninfected recipients is a potential avenue to increase rates of kidney transplantation without significant adverse outcomes in the early postoperative period. In addition, HCV- recipients who acquire HCV can be successfully treated. Our case is also unique in that the recipient was successfully treated for the HCV genotype 1A before transplant and later infected with HCV genotype 2 from the donor kidney and successfully treated post-transplant while maintaining excellent allograft function.

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