Use of hepatitis C-positive donors for kidney transplantation

The use of kidneys from donors with a positive serology for hepatitis C virus (HCVD+), as a way of increasing the donor pool, is still a matter of controversy. Although there is an almost universal consensus that kidneys from HCVD+ should not be used into hepatitis C virus (HCV)-negative recipients, its use in patients with a positive serology for HCV is still under review. Unicenter experiences have demonstrated that, even in the long run, HCV-positive recipients exhibit a similar outcome for graft and patient survival and biochemical behavior of the liver disease, independently of the HCV serology of the donor. In fact, based on these institutional studies, European and American Guidelines recommend the use of these kidneys into HCV RNA-positive recipients. Additional data from registry studies raised caution about a decreased survival in recipients of kidneys from HCVD+, although their survival was superior to that observed in patients remaining in the waiting list. Many questions remain to be solved through prospective and multicenter studies. Meanwhile, the use of kidneys form HCVD+ into HCV RNA-positive recipients may be considered a reasonably safe way of using these kidneys that otherwise would be lost.