*Purpose: The use of hepatitis C virus (HCV) positive organs for transplant to HCV negative recipients has been reported on and has gained popularity across kidney, liver, heart, and lung transplantation. Currently, limited reports discuss HCV positive to negative transplantation specifically in pancreas transplantation. The most recent SRTR/OPTN Report shows < 0.3% of all pancreas transplants are HCV(+) to (-). The presented study examines a cohort of HCV(-) pancreas recipients who received HCV(+) grafts.

*Methods: This is a single center, retrospective study of pancreas transplant recipients from May 2019 – October 2020. Patients were included if they received a HCV(+) (NAT+/Ab+ or NAT-/Ab+) transplant and were HCV(-) (NAT-/Ab-) at the time of transplant. Patients that seroconverted and developed a positive viral load were initiated on direct acting antiviral therapy once approved by their insurance post-transplant. Patients were considered cured if they exhibited sustained virologic response rates (SVR) 12 weeks following the end of therapy. Outcomes assessed include waitlist time, time to medication obtainment, viral clearance, and graft survival.

*Results: Six simultaneous kidney-pancreas recipients were included in this study. Five patients (83.3%) had NAT(+) donors while 1 (16.7%) had a NAT(-)/Ab(+) donor. The average time from listing to transplantation was 82 days, and 3 out of 6 patients were transplanted within 15 days of their listing date. Of the 5 patients who received NAT+ grafts, 3 (60%) were treated with glecaprevir/pibrentasvir and 2 were treated with sofosbuvir/velpatasvir. The average time from transplant to the start of HCV therapy was 41 days, all paid for by commercial insurance. All patients (n=3) who are 12 weeks past the end of therapy have achieved SVR12. The patient who received a NAT(-)/Ab(+) graft has remained HCV(-) for all 11 months post-transplant. There have been no graft failures or rejection episodes, however one patient died 2 months post-transplant (not thought to be related to HCV or the treatment regimen). All other patients remain off insulin and have a mean creatinine of 1.4 mg/dL.

*Conclusions: Hepatitis C negative kidney-pancreas transplant recipients can safely receive HCV(+) grafts and be cured of HCV post-transplant similar to other organ groups. Benefits in terms of waitlist time reduction and long-term outcomes will need to be studied further

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