Version July 2025
HCV: hepatitis C virus; RNA: ribonucleic acid.
* Donors who have detectable HCV antibody but are HCV RNA negative are considered to have cleared the infection (either spontaneously or through antiviral treatment) and do not have active viremia. The risk of transmission of HCV from such patients is extremely low, and kidney transplantation from such donors is considered a safe approach.
¶ HCV RNA-positive living donors should be assessed for liver fibrosis, as the presence and extent of fibrosis may impact their eligibility to donate a kidney. While liver disease is not defined as an absolute contraindication by the Organ Procurement and Transplantation Network (OPTN), it may be a relative contraindication beyond OPTN requirements at some centers. The presence of significant liver disease with synthetic and functional abnormalities is considered an absolute contraindication for donation.
Δ The vast majority of HCV infections can be successfully treated with short (8- to 12-week) direct-acting antiviral regimens. Successful antiviral treatment results in sustained virologic response at 12 weeks, which is considered a marker for cure of HCV infection. If transplantation cannot be delayed for the 8 to 12 weeks of treatment and if a timely transplant would be highly beneficial for the recipient, antiviral treatment can be delayed until after transplantation (and the recipient should be managed in the same way as recipients of a kidney from a deceased donor with HCV viremia). Refer to UpToDate content on the selection of antiviral treatment for chronic HCV infection.
◊ Institutional practices and policies regarding the use of kidneys from HCV RNA-positive donors vary among transplant centers in the United States and around the world. Many centers do not perform kidney transplantation using HCV RNA-positive donors, whereas some centers may only allow transplantation of HCV RNA-positive kidneys into recipients with HCV.
§ Since the HCV genotype of the donor is often unknown, a pangenotypic antiviral regimen is recommended for recipients of HCV RNA-positive kidneys. Refer to UpToDate content on antiviral regimen selection for recipients of HCV RNA-positive kidneys.
¥ If the donor HCV RNA results were not available prior to transplant and the recipient had started antiviral therapy presumptively, antiviral therapy can be stopped if testing confirms that HCV RNA was undetectable in the donor.