*Purpose: Recently, there has been a marked increase in the availability and use of kidneys from hepatitis C virus (HCV) positive deceased donors for transplantation. This study aims to evaluate the outcome, safety and feasibility of transplantation of kidneys from HCV-positive donors to HCV-negative recipients.

*Methods: A prospective single-institution review of 30 sequential kidney recipients performed between 3/2019 and 10/2019 that received organs from donors who were HCV nucleic acid test (NAT) and anti-HCV antibody positive. All recipients were HCV NAT and anti-HCV antibody negative at the time of transplant. All recipients had T cell depletion and triple immunosuppression. Data collected included donor and recipient demographics, direct antiviral agent treatment regimens, liver function, kidney graft outcome, and de novo donor-specific antibodies.

*Results: The mean recipient age was 59 ±10. 70% were male, and 50% were Caucasian. The mean waiting time on the transplant list was 1280 ± 630 days. The mean follow up time was 149 ±80 days. The mean donor age was 36 ±10, 59% were male, and 93% were Caucasian. The mean kidney donor profile index was 63 ±12. 8 (27%) were deceased after cardiac death donors. The cold ischemic time median (IQR) was 25 (18-29) hours. 28 recipients (93%) developed HCV viremia and received treatment; 17 (61%) had genotype 1a HCV. Interestingly, 2 recipients (7%) remain HCV NAT negative after transplantation. The mean time between transplantation and treatment initiation was 44 ±10 days. 18 patients (64%) received glecaprevir/pibrentasvir and 10 patients (36%) received ledipasvir/sofosbuvir. 20 patients (71%) completed direct antiviral agent therapy; of those, 3 patients (15%) had a sustained virologic response at 12 weeks (SVR12). 1 patient continued to exhibit HCV viremia after the end of treatment. 8 patients (29%) remains on treatment. 20 patients (67%) had delayed graft function. The mean estimated GFR (eGFR) at 12 weeks after transplantation (mL/min/1.73 m2) was 49 ±13, and at the end of hepatitis C treatment was 48 ±18. 5 patients (17%) had BK viremia after transplant, and 5 patients (17%) had CMV viremia. 4 patients (13%) had De novo DSA; 3 class I and 1 class II. 2 patients (7%) had mild cellular mediated rejection. All patients tolerated the hepatitis C therapy. Transaminitis occurred in 9 recipients (30%), with at least 3 times normal aminotransferase levels, no recipients had evidence of advanced hepatic dysfunction or graft loss.

*Conclusions: Kidney transplantation from HCV infected donors to HCV negative recipients should be considered in all eligible patients. However, a combination of high kidney donor profile index, HCV positive graft and elderly recipient may result in higher rate of delayed graft function .

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