The development of direct-acting antiviral agents for the treatment of Hepatitis C (HCV) has changed the practice of treating patients with HCV. In particular, organ transplant recipients who have not previously been exposed to HCV are now able to consider receiving an organ from a donor who is infected with HCV, and anticipate effective antiviral therapy after transplantation. As a result of the opioid epidemic, the proportion of young, relatively healthy individuals dying from overdose has risen. The proportion of these individuals who are infected with HCV is significant. Many institutions have begun consenting HCV naïve patients with organ failure for receipt of organs from donors who have HCV with positive nucleic acid testing (NAT). One of the most robust fields of solid organ transplantation with HCV NAT+ donors is kidney transplantation. There have been many different strategies and barriers addressed through years of literature. Post-transplant outcomes have not demonstrated significantly increased risk in regards to death or organ rejection compared to a control group of kidney transplant patients. In addition, patients who undergo antiviral therapy after organ transplantation have demonstrated high rates of sustained virologic response (SVR). This review paper examines the background of HCV NAT+ transplantation, examines several landmark research manuscripts, and addresses those areas of ongoing controversy regarding the considerations of transplantation with HCV NAT+ organs into HCV naïve recipients.

Kidney transplant, Hepatitis C, Direct-acting antivirals, Solid organ transplant