A Case of Graft-Versus-Host Disease in a Liver Transplant Recipient Receiving an HCV NAT Positive Organ: Does HCV NAT Matter?

INTRODUCTION: Graft-versus-host disease (GVHD) is a rare but fatal complication in solid organ transplant. Ruxolitinib is a JAK-1/2 inhibitor that has been utilized mostly in hematopoietic stem cell transplant (HCST) GVHD and has limited data for its use in solid organ transplant GVHD.

CASE: A 57-year-old female presented for orthotopic liver transplant for metabolic and alcohol associated liver disease (metALD) and received an HCV NAT positive organ. One month after her transplant, patient was found to have rash and gastrointestinal complaints which were biopsied and scoped, showing findings of GVHD. Patient's serum was tested for donor lymphocytes which revealed 45% donor lymphocytes. She started on intravenous methylprednisolone and ruxolitinib. HCV PCR was also increasing at the time of her diagnosis of GVHD, so patient started on glecaprevir/pibrentasvir as well. After starting ruxolitinib and methylprednisolone, patient's donor lymphocytes decreased and remained undetectable. Finally, patient also achieved SVR at 12 weeks following treatment.

DISCUSSION: Ruxolitinib has demonstrated to be efficacious with treating GVHD in the solid organ transplant population. There are hypothetical effects of HCV on immune system markers, but from this case report it appears that concurrently treating GVHD with ruxolitinib and HCV with glecaprevir/pibrentasvir does not affect patient outcomes.

CONCLUSION: Treating GVHD with ruxolitinib and HCV with glecaprevir/pibrentasvir simultaneously is both effective and safe.