*Purpose: The advent of combination direct-acting antiviral (DAA) agents has improved the ability to treat hepatitis C virus (HCV) infections. As a result, utilization of HCV-positive donor organs for transplantation has increased. In August 2019, our academic medical center implemented protocols to utilize HCV-positive donor organs in HCV-negative recipients. The purpose of this study is to describe outcomes associated HCV viremic organ donation one year after these protocols were implemented.

*Methods: A retrospective chart review of hepatitis C viremic organ donation at Nebraska Medicine between August 2019 and August 2020. Adult patients who received a heart, lung, liver, or kidney from a HCV-positive donor, developed HCV viremia post-transplant, and were treated with a direct-acting antiviral (DAA) agent were included. Patients who received a donor organ with a negative nucleic-acid test (NAT) regardless of a positive HCV antibody test were excluded.

*Results: Twenty-seven adult patients at our institution received an organ transplant from a HCV-positive donor. Of these patients, one was excluded as they had not developed HCV viremia post-transplant by the time data was censored. One additional patient was excluded as they did not have a HCV quantitative level drawn 12-weeks post-DAA treatment. All 25 patients included in our study achieved SVR12. The majority of patients (72%) had undetectable HCV RNA levels by week 4 of treatment. The median number of days from transplant to detection of HCV viremia was 5 days [IQR 3,7]. The median number of days to treatment initiation from detection of HCV viremia was 17 days [IQR 13,37]. Twenty-two (88%) patients in the study received first-line HCV treatment with glecaprevir/pibrentasvir per protocol. Three patients (12%) received second-line treatment with sofosbuvir/velpatasvir due to insurance preference or due to a drug-interaction with immunosuppression. No patients developed biopsy-proven acute cellular rejection.

*Conclusions: This study found 96% of patients who received a HCV-positive donor organ went on to develop HCV viremia post-transplant. Of the patients who developed HCV post-transplant, the majority cleared their infection by week 4 of HCV treatment. SVR12 was achieved in 100% of patients- indicating a durable response. All patients received some form of insurance coverage or financial assistance for their HCV treatment. These outcomes support the utilization of HCV viremic donor organs to expand the donor pool.

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