Anecdotal reports have suggested that transplantation of HCV Ab+/NAT- donor kidneys into HCV negative recipients is safe and not associated with HCV transmission. With the shortage of donor kidneys and the longest waitlist time of close to 10 years in our DSA, we started offering HCV Ab+/NAT- donor kidneys to our patients. Methods. A retrospective review was conducted of HCV negative patients who received kidney allografts from donors who were HCV Ab+/NAT-. All patients received thymoglobulin induction and tacrolimus, MMF, and steroids post-transplant; none received IVIg. Recipient serologic and NAT testing was done 1- and 3-months post-transplant. Results. Twenty-five patients have been transplanted; recipient and donor demographic data are listed below (Table). All patients were HCV Ab negative prior to transplant. The mean follow-up post-transplant was 4.1 ± 1.8 months; 18 patients have >3 months follow-up while 7 have >1 but <3 months of follow-up. 11 (44%) patients had delayed graft function; all have come off dialysis. 1- and 3- month serum creatinine levels were 1.6 ± 0.8 mg/dl and 1.2 ± 0.4 mg/dl, respectively. Thirteen (52%) donors met PHS increased risk status: 9 from a history of IV drug use, 5 from high risk sexual behavior, and 2 from a history of incarceration. Median time from donor admission to serologic and NAT testing was 4 days. There was no transmission of HIV or HBV infection. Interestingly, 10 (40%) patients seroconverted and became HCV antibody positive. However, all 25 patients and 18 patients, respectively, remained HCV RNA negative at 1- and 3-months post-transplant. Conclusion. Transplantation of HCV Ab+/NAT- kidneys to HCV negative recipients is safe and does not lead to HCV transmission. However, a significant proportion of recipients develop new antibody positivity. The mechanism is unknown and further study of this phenomenon may yield new insights into HCV immunology.

CITATION INFORMATION: de Vera M., Volk M., Ncube Z., Kore A., Robinson M., Wai P., Blais S., Baron P., Villicana R. Transplantation of Kidneys from Hepatitis C Virus (HCV) Antibody (Ab) Positive, NAT Negative Donors to HCV Negative Patients Results in Seroconversion but Not Viral Transmission Am J Transplant. 2017;17 (suppl 3).

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