Renal transplantation from donors with a positive serology for hepatitis C

Transplantation of kidneys from donors with a positive serology for hepatitis C virus (HCVD+) remains controversial as made evident by wide variations in practice. Current knowledge derived from unicenter and registry experiences have demonstrated that the use of HCVD+ kidneys in HCV+ recipients seems to be safe in the long-term. This information, summarized in this chapter, has provided the basis for internationally agreed recommendations which limit the use of these kidneys for transplantation in recipients with a positive HCV RNA while on the waiting list and consenting in advance. Avoiding superinfection might require matching donors and recipients based on the involved HCV genotype, an approach limited by obvious time constraints. Because the incidence and prevalence of HCV infection is decreasing and there is a proactive treatment of patients with end-stage renal disease and HCV infection before being included on the waiting list, kidneys from HCVD+ are becoming surplus organs due to the lack of appropriate recipients. The underutilization of these kidneys at a moment of dramatic organ shortage requires organizational measures, including the offer of these kidneys for preemptive transplantation, besides the need of reviewing the evidence driving local criteria.