Mark Schnitzler

Background With the introduction of direct‐acting antiviral therapies (DAAs), the non‐use rate of hepatitis C virus (HCV)‐positive donor organs (D+) has decreased significantly. We present the donor, recipient, and transplant allograft characteristics, along with recipient outcomes, in one of the largest cohorts of HCV‐D+ transplants into HCV‐naïve recipients (R−). Methods Charts of HCV D+/R− kidney (KT), liver (LT), and simultaneous liver‐kidney (SLKT) transplant recipients between January 2019 and July 2022 were reviewed. Primary outcomes of interest included waitlist times and 1‐year graft failure. Secondary outcomes included hospital and intensive care unit length of stay, post‐transplant complications, effectiveness of DAA therapy, and characteristics of patients who relapsed from initial DAA therapy. Results Fifty‐five HCV D+/R− transplants at our center [42 KT (26 nucleic acid testing positive [NAT+], 16 NAT−), 12 LT (eight NAT+, four NAT−), and one SLKT (NAT+)] had a median waitlist time of 69 days for KT, 87 days for LT, and 15 days for SLKT. There were no graft failures at 1 year. All viremic recipients were treated with a 12‐week course of DAAs, of which 100% achieved end of treatment response (EOTR)—85.7% ( n = 30) achieved sustained virologic response (SVR) and 14.3% relapsed ( n = 5; four KT, one LT). All relapsed recipients were retreated and achieved SVR. The most common post‐transplantation complications include BK virus infection ( n = 9) for KT and non‐allograft infections ( n = 4) for LT. Conclusions Our study has demonstrated no graft failures or recipient deaths at 1 year, and despite a 14.3% relapse rate, we achieved 100% SVR. Complications rates of D+/R− appeared comparable to national D−/R− complication rates. Further studies comparing D+/R− to D−/R− outcomes are needed.