Very late relapse of hepatitis C virus infection immediately after liver transplant

Late relapse of hepatitis C virus (HCV) infection is very rare in the era of modern direct‐acting antiviral therapy. We report here the first case of a late relapse, after direct‐acting antiviral therapy, occurring immediately after liver transplant ( LT ), with 93 weeks of sustained virologic response before LT . HCV RNA in serum and in liver biopsy was negative the day of LT, and relapse was diagnosed 11 days after LT . HCV NS 5A sequencing was performed on samples before and after LT, with 99% of homology demonstrating a true late relapse rather than a reinfection. This late relapse could be explained by extrahepatic reservoirs of HCV and the high immunosuppressive therapy, including bolus of steroids, within the first days post LT . In conclusion, our case suggests that monitoring HCV RNA after LT could be recommended to detect and treat early relapse, even after a long virologic response.