The continued organ shortage in renal transplantation (RT) has stimulated use of organs from increased-risk donors to expand the donor pool. The rate of denovo Hepatitis C (HCV) infection from the use of HCV antibody (HCVAb) positive and HCV nucleic acid test (HCVNAT) negative kidney allografts is unknown. Study aim was to prospectively analyze RT outcomes from HCVAb+/NAT- donors to HCV naïve recipients under T-cell depleting early steroid withdrawal (ESW) immunosuppression (IS).

Methods: HCV naïve RT recipients transplanted with a HCVAb+/NAT- allograft (Dec 2015-Nov 2017) were prospectively reviewed. Donor/recipient characteristics, IS strategies, and clinical outcomes (allograft function, graft/patient survival, and de novo HCV infection) were collected. Per center monitoring guidelines, recipients underwent HCV PCR testing (Roche COBAS® Ampliprep TNAI/ TaqMan® 48 RUO Assay; limit of detection 15 IU/ml) at 3 months post-RT or sooner if clinically indicated.

Results: Kidneys from 32 HCVAb+/NAT- donors were transplanted to 43 HCVAb- recipients at 2 centers. Analysis includes 25 recipients (allografts from 22 donors) with 3-month follow-up. Table 1 summarizes donor/recipient characteristics. HCVNAT testing within the eclipse period occurred in 95% of donors. IS received by 96% included anti-thymocyte globulin, tacrolimus, and 7-day ESW. Rate of de novo HCV infection is 4% (1/25). HCV viremia at 92 days post-RT in a 61 year old male transplanted for IgA nephropathy; initiation of anti-viral therapy (glecaprevir/pibrentasvir for 12 weeks) is underway. One death at 261 days post-RT due to unknown causes (autopsy not performed) was determined not related to HCV or donor factors. Table 2 summarizes clinical outcomes.

Conclusion: This represents the largest, prospective series of HCVAb+/NAT- donors transplanted to HCV naive recipients with a 4% rate of HCV transmission under T-cell depleting ESW IS. Our experience demonstrates an effective strategy to expand the donor pool, decrease waitlist times, and decrease discard rates of HCV positive kidneys.

CITATION INFORMATION: Dao A., Cuffy M., Kaiser T., Loethen A., Cafardi J., Shields A., Cardi M., Alloway R., Govil A., Sherman K., Shah S., Woodle E. Use of HCV Ab+/NAT- Donors in HCV Naïve Renal Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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