*Purpose: Hepatitis C virus (HCV) + organs are increasingly use to transplant HCV naive candidates with good short-term outcomes. HCV transmission with HCV nucleic acid test (NAT) + donor is near to 100%. HCV-seronegative NAT+ donors indicate acute infection and carry high risk for infection transmission. Here we report a case series of solid organ transplant recipients (SOTR) of HCV NAT+ organs who did not develop viremia in their post-transplant period.

*Methods: Retrospective review of adult HCV naive SOTR receiving HCV NAT+ organs since 10/2018. SOTR data obtained from electronic medical record and donor data from DonorNet.

*Results: Out of 118 SOTR receiving HCV-positive organs, we identified 10 HCV naive SOTR receiving organs from 9 different HCV NAT+ donors without evidence of HCV transmission. Donors had a mean age of 35±16 y, 22% females, 22% Black, 22% history of IV drug use, 44% died from CVA/stroke. All donors were HCV NAT+, 44% were HCV seropositive. Median time of NAT collection to transplant was 34.4 hours. Recipients mean age was 56±9 y, 50% females, 50% Black and 60% received a kidney or kidney-pancreas transplant. All recipients were HCV seronegative. Anti-thymocyte globulin induction was given to 60% of recipients and 90% were maintained on triple immunosuppression. Median recipient follow up was 349 days (IQR 246-423). By 1 month post-transplant, all recipients had negative HCV viral load (VL). At 3 months, most recipients (80%) remained without detectable viremia including 1 liver recipient. From 2 SOTR without 3 month data, 1 had the 3 month VL pending at the time of this abstract and 1 had died from non-HCV related complications. HCV viremia details in Table 1.

*Conclusions: Despite the high risk of HCV transmission when transplanting HCV NAT+ organs into naive recipients, we identified 10 SOTR where transmission did not occur at last follow up. This finding may be due to a low HCV viral replication at time of procurement and further virion removal through post-recovery organ washout. It is also possible HCV NAT testing was falsely positive, despite its high sensitivity and specificity (>98 and 99%, respectively). In conclusion, the infectivity of all HCV NAT+ donors may not be the same and thus, HCV NAT+ organs should continue to be used with confidence to expand access to a scarce resource.

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