*Purpose: Several small studies have shown that transplanting a hepatitis C virus (HCV) negative recipient with a HCV positive donor is feasible in a research setting. In February 2018 we began transplanting HCV negative recipients with HCV positive donors as standard of care.

*Methods: All patients, except those with previously cured HCV and those with cirrhosis, were consented for HCV positive donor kidneys. After transplantation, patients were tested for HCV RNA until viremic. A direct acting antiviral (DAA) agent was prescribed based on genotype and insurance approval. Sustained virologic response (SVR) at weeks 4, 12 and 24 were recorded. Renal function and cold ischemic time were also evaluated.

*Results: We performed 25 HCV positive donor kidney transplants from February 2018 through October 2018. Recipient and donor demographics are described in Table 1. All patients received basiliximab and maintenance with tacrolimus, mycophenolate mofetil and prednisone. Viral kinetics and responses are described in Table 2. Average time from viremia to start of DAA was 15.8 ± 10.4 days. The most common genotype was 1a (60%), followed by 3a (28%). The most commonly prescribed DAA was ledipasvir and sofosbuvir (56%) followed by velpatasvir and sofosbuvir (32%) then glecaprevir and pibrentasvir (12%). Eleven patients had a detectable HCV RNA at SVR4 with a median of 109 copies/mL (IQR 7, 251). Three patients had a detectable HCV RNA at SVR 12, which was detected &lt 12 copies/mL, the lower limit of quantification of our lab. Eight patients achieved clearance at SVR24, while one patient had a detectable level at SVR24 which was a new genotype from when therapy was started. Patient and graft survival was 100% and 96%, respectively. No patients developed clinical liver disease.

*Conclusions: HCV negative recipients can be safely and successfully transplanted with HCV positive donor kidneys outside of a research protocol. HCV organs can expand the organ pool and should no longer be considered experimental. We believe the use of these organs in HCV negative recipient’s decreases waiting time, have excellent outcomes and should be considered standard of care.

« Back to 2019 American Transplant Congress