*Purpose: Pancreas transplantation (PT) is the best long-term option for patients with labile diabetes and end-stage-renal disease. The mortality on the waitlist is high; patients should receive a transplant as early as possible. There remains a shortage of high-quality organ donors suitable for pancreas (and kidney) transplantation. PT in HCV positive recipients using a negative donor (R+/D-) has been performed but not vice versa (no R-/D+ transplants). After the advent of new, oral, and direct-acting antiviral agents, the option to use HCV+ deceased donor organs has become possible; anti-HCV treatment is started right after transplant.

*Methods: All reported cases of R+/D- and R-/D+ transplants performed since 1/1/2019 were included in this study. Descriptive analysis of patient, donor characteristics, and outcome was performed. Patient and graft survival was assessed using the Kaplan-Meier method.

*Results: 38 R+D-, 36 R-D+, and 2 R+D+ transplants were identified. The majority were simultaneous pancreas kidney (SPK) transplants. Only one R-D+ pancreas after kidney transplant (PAK), and 8 pancreas transplants alone (PTA all R+D-) were performed. Tables 1 and 2 show donor and recipient characteristics for SPK transplants. The donors were excellent young donors, mostly males dying of trauma, but, in the R-D+ category, in the majority previous drug users. Notably, the waiting-time for R-D+ recipients was under 3 months in 50% of transplants. Outcome of the HCV NAT test at 6 months is shown in Table 3. The 2 positive patients at 6 months were negative at 1 year follow-up. Patient and graft survival is shown in Table 3. The 3 early deaths in the R-D+ group were 1 trauma, 1 bacterial infection due to technical problems, and 1 possible COVID-19 infection. All 3 patients died with functioning pancreas and kidney grafts.

*Conclusions: Pancreas transplantation is considered by many a non-life-saving procedure and, therefore, patients and donors are carefully chosen. What is neglected is the fact that the mortality of diabetic patients while waiting is high. Hence, it is essential to transplant as early as possible. In contrast to solitary pancreas transplants, the SPK waiting time is long. The advent of new HCV treatment modalities makes safe and successful transplants possible for HCV+ recipients and from HCV+ donors possible. HCV+ donors are usually young and excellent donors who fulfill acceptance criteria for pancreas transplantation. Follow-up time for patients in this study is short, but our preliminary results show that the use of an HCV+ donor results in safe and successful pancreas transplant outcome.

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