Rituximab Therapy for Post-Liver Transplant Membranoprolifertive Glomerulonephritis Associated with Hepatitis C Viral Infection

ABSTRACT

Post-transplant membranoprolifertive glomerulonephritis(MPGN), due to hepatitis C virus, is a serious immunecomplex disease with potential for both kidney and liver loss.Treatment with corticosteroids and immunosuppressive canactivate viral infection and the use of interferon alpha caninduce acute rejection of the transplanted liver. In this casereport; a lady, with hepatitis C genotype 4, had developedsevere nephrotic syndrome with progressive renal failure dueto MBGN following liver transplant. Initially, she had receivedHarvoni (Ledipasvir/sofosbuvir) 90/400 mg daily for 12 weeks.Despite, clearance of hepatitis C viremia, she did not improve.Hence, Rituximab was started. Fortunately, her renal failureand nephrotic state improved without activation of hepatitis Cinfection or induction of rejection.