Utilization of Organs from Hepatitis C-Antibody-Positive or RNA-Positive Donors in Kidney Transplantation: A Single-Center Retrospective Analysis of Outcomes and Safety

<b>Background/Objectives</b>: The shortage of donor organs in transplant medicine remains a challenge. Kidney transplantation from Hepatitis C (HCV)-positive donors to HCV-negative recipients expands the donor pool. Limited data suggest this approach as safe when combined with modern antiviral therapies. This study evaluates the safety of such transplantations in terms of viral transmission and graft function. <b>Methods</b>: A retrospective analysis of 205 kidney transplantations at the University Medical Center Marburg (January 2017-January 2024) was conducted. Eight recipients received kidneys from HCV-antibody-positive (HCV-Antibody+) and RNA-negative donors (HCV-RNA-), and five received kidneys from HCV-RNA-positive (HCV-RNA+) donors. Recipient demographics, donor factors, and transplantation parameters were analyzed. Repeated virological surveillance as well as graft function and complications were assessed within the first year after transplantation. <b>Results</b>: HCV-RNA+ donor recipients received Glecaprevir/Pibrentasvir for three months starting immediately at transplantation, while HCV-Antibody+ and HCV-RNA- donor recipients did not receive antiviral therapy. After 12 months, both groups exhibited comparable graft function (serum creatinine: HCV-Antibody+/RNA- 1.3 ± 0.4 mg/dL vs. HCV-RNA+ 1.8 ± 0.5 mg/dL, <i>p</i> = 0.6) without proteinuria. No hepatic complications or significant inflammation occurred. No HCV-RNA was detected in any patient at any time under the selected treatment regimen. <b>Conclusions</b>: This single-center study supports the safety of kidney transplantation from HCV-positive donors. Preemptive Glecaprevir/Pibrentasvir therapy effectively prevents HCV transmission, offering a viable option to expand the donor pool.